IOL calculation accuracy in patient undergoing cataract extraction and IOL implantation in conjunction with Descemet membrane endothelial keratoplasty (DMEK)

Purpose. To evaluate the clinical outcomes of Descemet membrane endothelial keratoplasty (DMEK) for vitrectomized eyes that underwent pars plana vitrectomy (PPV) and transscleral-sutured intraocular lens (IOL) implantation. Methods. In this retrospective study, DMEK cases were reviewed from medical records and divided into two groups: the eyes after PPV and transscleral-sutured IOL implantation (vitrectomized group) and the eyes with in-the-bag IOL implantation (control group) prior to DMEK. The main outcome measures included time of graft unfolding during surgery and best spectacle-corrected visual acuity (BSCVA), central corneal thickness (CCT), and endothelial cell density (ECD) at 1, 3, and 6 months after the DMEK. Results. Twenty-three eyes (vitrectomized group, n=8; control group, n=15) in 23 patients were included in this study. The unfolding time was significantly longer in the vitrectomized group than in the control group (P<0.001). Postoperative BSCVA was worse in the vitrectomized group (0.16 ± 0.15) than in the control group (−0.06 ± 0.06; P=0.017). The improvement in BSCVA was negatively correlated with the patients’ age and frequency of previous surgeries. Conclusions. Despite the longer graft unfolding time and limited visual recovery, DMEK should be applicable to vitrectomized eyes with transscleral-sutured IOL implantation.

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Refractive accuracy in eyes undergoing combined cataract extraction and Descemet membrane endothelial keratoplasty

British Journal of Ophthalmology ◽

10.1136/bjophthalmol-2020-317247 ◽

2021 ◽

pp. bjophthalmol-2020-317247

Author(s):

Jack A Campbell ◽

John G Ladas ◽

Kendrick Wang ◽

Fasika Woreta ◽

Divya Srikumaran

Keyword(s):

Corneal Thickness ◽

Cataract Extraction ◽

Absolute Error ◽

Corneal Dystrophy ◽

Endothelial Keratoplasty ◽

Descemet Membrane Endothelial Keratoplasty ◽

Optical Biometry ◽

Corneal Power ◽

Descemet Membrane ◽

The Difference

PurposeTo evaluate the refractive accuracy of current intraocular lens (IOL) formulas and propose a modification in calculation of corneal power in eyes undergoing combined cataract extraction and Descemet membrane endothelial keratoplasty (DMEK).DesignRetrospective cohort study.MethodsPatients with Fuchs endothelial corneal dystrophy undergoing uncomplicated combined cataract surgery and DMEK at a single institution were included. The Hoffer Q, SRK/T, Holladay I, Barrett Universal II and Haigis formulas were compared. A modified corneal power was calculated using a thick lens equation based on anterior and posterior corneal radii and corneal thickness from Pentacam imaging. Error calculations were adjusted based on the difference in optical biometry and the modified corneal power. Mean absolute error (MAE) for each formula was compared between the corneal power modification and optical biometry corneal power.ResultsIn 86 eyes, the mean error ranged from 0.90 D for the Barrett Universal II formula to −0.10 D for the Haigis formula, with 4 of 5 formulas resulting in a mean hyperopic error. The corneal power modification resulted in a significantly lower MAE for the Hoffer Q (0.82 D), Holladay I (0.85 D), SRK/T (0.85 D) and Barrett Universal II (0.90 D) formulas compared with optical biometry corneal power for the Hoffer Q (1.02 D; p<0.005), Holladay I (0.97 D; p<0.005), SRK/T (0.93 D; p<0.01) and Barrett Universal II (1.16 D; p<0.005) formulas.ConclusionsAll formulas except the Haigis formula resulted in a hyperopic error. The corneal power modification significantly reduced error in four out of five IOL formulas.

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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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