Phaco after Descemet's membrane endothelial keratoplasty?

Unlike Descemet's-stripping automated endothelial keratoplasty (DSAEK) or Descemet's-stripping endothelial keratoplasty (DSEK), phacoemulsification before or during Descemet's membrane endothelial keratoplasty (DMEK) may initially be avoided. However, these patients may require cataract surgery in the future. Researchers at a tertiary referral centre conducted a comparative case series study to evaluate the refractive and visual outcomes, the potential graft damage during or after phacoemulsification, and other complications of phacoemulsification after DMEK. A review of a series of 106 consecutive phakic DMEK eyes showed that five eyes (4.7 per cent) required phacoemulsification a mean of 9.2 months ± 3.7 (SD) (range four to 14 months) after the initial DMEK. All phacoemulsification procedures were uneventful, and no dislocations and/or detachments of the Descemet’s graft were observed. At six to 12 months, all eyes reached a corrected distance visual acuity of 20/30 (0.6) or better and were within ±0.50 D of the target refraction. Endothelial cell density decreased from a mean of 1535 ± 195 cells/ mm2 before phacoemulsification to 1158 ± 250 cells/mm2 six to 12 months after phacoemulsification. No significant changes in pachymetry values were observed, and all corneas remained clear throughout the study. The researchers conclude that phacoemulsification after DMEK can be performed with minimal risk for graft detachment. The postoperative refractive outcomes were predictable, and visual acuity is likely to improve. F Musa et al, JCRS, “Outcomes of phacoemulsification after Descemet's membrane endothelial keratoplastyâ€, Vol. 39, Issue 6.