Descemet Membrane Endothelial Keratoplasty and light adjustable lens triple procedure

Purpose To report a case of Descemet membrane endothelial keratoplasty (DMEK) performed with phacoemulsification and intraocular lens implantation (triple procedure) for coexisting keratoconus (KC), Fuchs endothelial dystrophy (FED), and visually significant cataract. Case description One eye of one patient with moderate and stable KC, FED, and visually significant cataract was treated with combined DMEK and phacoemulsification with intraocular lens implantation (triple procedure). Visual acuity and corneal reflectivity/densitometry, thickness, and topographic measurements were recorded and compared to their preoperative values. At all postoperative time points, the endothelial graft was found to be completely attached. By 3 months postoperatively, the patient's best spectacle corrected vision had improved from 20/50 (0.4) to 20/25 (0.8) where it remained stable. No intra- or postoperative complications were experienced. Conclusions DMEK may be an effective alternative to penetrating keratoplasty in eyes with coexisting stable KC and FED.

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Faculty Opinions recommendation of Efficacy of descemet membrane endothelial keratoplasty: clinical outcome of 200 consecutive cases after a learning curve of 25 cases.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.13410959.14782059 ◽

2011 ◽

Author(s):

H Burkhard Dick ◽

Ingo Schmack

Keyword(s):

Clinical Outcome ◽

Learning Curve ◽

Endothelial Keratoplasty ◽

Descemet Membrane Endothelial Keratoplasty ◽

Descemet Membrane

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Descemet membrane suturing to manage recurrent graft detachment in a patient with Descemet membrane endothelial keratoplasty on failed penetrating keratoplasty

Therapeutic Advances in Ophthalmology ◽

10.1177/25158414211027705 ◽

2021 ◽

Vol 13 ◽

pp. 251584142110277

Author(s):

Zahra Ashena ◽

Thomas Hickman-Casey ◽

Mayank A. Nanavaty

Keyword(s):

Visual Acuity ◽

Penetrating Keratoplasty ◽

Anterior Segment ◽

Endothelial Keratoplasty ◽

Descemet Membrane Endothelial Keratoplasty ◽

Descemet Membrane ◽

Ocular Coherence Tomography ◽

Corrected Visual Acuity ◽

Intracameral Injection ◽

History Of

A 65-year-old patient with history of keratoconus, mild cataract and penetrating keratoplasty over 30 years ago developed corneal oedema subsequent of graft failure with best corrected visual acuity (BCVA) of counting fingers. He underwent a successful cataract surgery combined with a 7.25 mm Descemet’s Membrane Endothelial Keratoplasty (DMEK) with Sodium Hexafluoride (SF6) gas. His cornea remained oedematous inferiorly at 4 weeks, despite two subsequent re-bubbling due to persistent DMEK detachment inferiorly. This was managed by three radial full thickness 10-0 nylon sutures placed in the inferior cornea along with intracameral injection of air. Following this, his anterior segment ocular coherence tomography (OCT) confirmed complete attachment of the graft, and the sutures were removed 4 weeks later. Unaided visual acuity was 20/63 and BCVA was 20/32 after 8 months. DMEK suturing can be helpful in persistent DMEK detachments, which is refractory to repeated re-bubbling due to uneven posterior surface of previous PK.

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