Descemet's Membrane Endothelial Keratoplasty and Phacoemulsification: Combined versus Sequential Surgery

Area of Science:

• Ophthalmology
• Corneal Surgery
• Endothelial Keratoplasty

Background:

• Fuchs endothelial corneal dystrophy (FECD) often requires corneal transplantation.
• Descemet membrane endothelial keratoplasty (DMEK) is an advanced endothelial keratoplasty technique.
• DMEK can be performed simultaneously with cataract surgery (triple procedure) or sequentially.

Purpose of the Study:

• To compare visual outcomes, endothelial cell loss, and complication rates of DMEK combined with phacoemulsification versus sequential DMEK.
• To evaluate the efficacy of a triple procedure versus a staged approach for FECD management.

Main Methods:

• Retrospective comparative case series of patients with FECD and cataract or prior cataract surgery.
• Group 1: Triple procedure (phacoemulsification with IOL implantation and DMEK).
• Group 2: Sequential DMEK after prior phacoemulsification with IOL implantation.

Main Results:

• No statistically significant difference in best corrected visual acuity (BCVA) at 6 months between groups (mean logMAR 0.07 in both).
• Similar endothelial cell loss at 6 months post-surgery (39.44% in Group 1 vs. 38.73% in Group 2, P=0.005).
• Comparable rates of total postoperative complications and rebubbling (13.5% vs. 12.5%, P > 0.05).

Conclusions:

• DMEK combined with phacoemulsification yields comparable visual outcomes to sequential DMEK.
• Endothelial cell survival and complication rates are similar between the triple procedure and staged approaches.
• The choice between combined or sequential DMEK can be based on individual patient factors without compromising outcomes.