Purpose: To evaluate the feasibility and outcome of combined Descemet’s membrane endothelial keratoplasty (DMEK), phacoemulsification and intraocular lens (IOL) implantation in the management of concomitant endothelial disorder, shallow chamber and cataract.
Setting: Clinical study at a tertiary referral center.
Methods: Prospective, nonrandomized study that included eight eyes of eight patients with concomitant endothelial disease and advanced cataract. In a first group of eight consecutive eyes, combined phacoemulsification, IOL implantation and DMEK wereperformed. Grafts were inserted with an ICL injector, encapsulated within viscoelastic plugs. Femtosecond laser-assisted descemetorhexis was performed in one case. The main
outcome measures were best spectacle corrected visual acuity (BSCVA), endothelial cell density (ECD) and intra- and postoperative complications.
Results: The procedure was successful in 75% (6/8) of cases. Two required a secondary regraft due to complete graft detachment and late failure. At six months, mean ECD loss was 55.4±24.0%, with an absolute mean ECD of 1248.3±755.0 cells/mm2. At six months, 100% (5/5) of patients with good visual potential reached BSCVA of ≥0.5, 80% (4/5) ≥0.8, and 60% (3/5) ≥1.0.
CONCLUSIONS: The combined triple procedure seems to be safe and effective in the management of cases with concomitant advanced Fuchs’ endothelial dystrophy, advanced cataract and shallow chamber. Endothelial cell density loss beyond six months remains under investigation.