Prospective Evaluation Of Sequential Versus Combined Cataract Surgery And Descemet Membrane Endothelial Keratoplasty (Triple Dmek)

To evaluate the clinical non-inferiority of Triple DMEK (Descemet Membrane Endothelial Keratoplasty) as compared to sequential cataract surgery and DMEK on the basis of prospective, randomized, controlled data. 

Department of Ophthalmology, Medical University of Vienna

This study is designed as a prospective, randomized, controlled trial. Included patients show clinically relevant senile cataract and Fuchs endothelial dystrophy. After randomization, cataract surgery and DMEK are performed either in separate surgeries or as one surgery (Triple DMEK). Patients are evaluated for macular thickness, Snellen visual acuity, contrast visual acuity, endothelial cell count, corneal densitometry, pachymetry and intraocular pressure prior to surgery, as well as at 1- and 3-month follow-up visits. At the 3-month follow-up visit, patients are asked to fill out the NEI VFQ-25 questionnaire in order to evaluate patient quality of life and satisfaction. Currently 30 patients have been included (halfway point).

Sequential and combined cataract surgery and DMEK appear to yield clinical results in all markers evaluated in this study. Visual rehabilitation is significant in both groups at the 1-month follow-up mark. Macular thickness has not increased significantly in either group, and endothelial cell density is comparable between groups. There have not been any adverse events. Results of the NEI VFQ-25 indicate a high degree of patient quality of life postoperatively in both groups. Scores are consistently, though insignificantly, higher in the group that received a Triple DMEK.

Clinically, sequential cataract surgery and DMEK and Triple DMEK appear to yield equal results. Considering that a large proportion of patients requiring DMEK are of working and caregiving ages, Triple DMEK could offer benefits regarding reduction of sick leave absences. Further, Triple DMEK could reduce costs by foregoing repeated processes in the context of each surgery (patient preparation, surgical theater preparation/cleaning etc) by performing a single surgery.