Chance Favours The Prepared Mind

Careful slit lamp examination of the cornea and specular microscopy should be done preoperatively in cases of corneal haze before planning for phacoemulsification, so as to avoid inadvertant descemet membrane detachments or persistent corneal edema in postoperative periods.

In cases of compromised corneal endothelium and hard cataracts, a combined endothelial keratoplasty with phacoemulsification can provide good results.

Case was performed in Delhi hospital, Dr Shroff's Charity eye hospital, New Delhi, India

A 76 year old lady, presented with complaints of decreased vision from left eye since 2 weeks which was accompanied with watering and redness after left eye phacoemulsification 2 weeks back elsewhere.

There was minimal visual regain after the cataract surgery. On slit lamp examination, Left eye had a descemet’s detachment for which descemetopexy with C3F8 was done, with minimal visual gain.

Right eye examination revealed posterior polymorphous corneal dystrophy, confirmed by histologic examination and AS-OCT.

Descemet’s stripping automated endothelial keratoplasty was done for the left eye and had a good postoperative visual recovery.

Patient on review after 6 months, wanted Cataract surgery in right eye.

Combined endothelial keratoplasty with phacoemulsification was planned for right eye, which produced very favourable outcomes.

Combined endothelial keratoplasty alongwith cataract surgery maybe required in some cases of corneal endothelial dystrophy. A good preoperative assessment including specular microscopy in cases of corneal haze should be performed before plannning for phacoemulsification for consistent results and ensuring patient satisfaction in the form of good visual outcomes.