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Rodríguez-Calvo-de-Mora M, Rocha-de-Lossada C, Romano V, Rodríguez-Vallejo M, Fernández J. Descemet membrane endothelial keratoplasty combined with presbyopia-correcting and toric intraocular lenses - a narrative review. BMC Ophthalmol 2023; 23:483. [PMID: 38007433 PMCID: PMC10675930 DOI: 10.1186/s12886-023-03240-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 11/21/2023] [Indexed: 11/27/2023] Open
Abstract
Fuchs endothelial corneal dystrophy (FECD) is the leading indication for EK and may coexist with cataract and presbyopia. Notably, the outcomes of phacoemulsification in FECD patients are not as favorable as those in eyes without this condition. Historically, only monofocal intraocular lenses (IOLs) were recommended for these patients. However, recent reports have described the implantation of Premium-IOLs (such as Multifocal IOLs, Enhanced Depth of Focus IOLs, and Toric IOLs) in FECD eyes undergoing cataract surgery and Descemet membrane endothelial keratoplasty (DMEK). While the results are encouraging, they are not as optimal as those from unoperated eyes, especially when comparing simultaneous procedures to sequential ones. It's advised to perform the DMEK first to improve the accuracy of IOL calculations. Still, even successfully operated eyes may experience secondary graft failure or graft rejection after DMEK. The success rate of a secondary DMEK is typically lower than that of the initial procedure. Furthermore, if the postoperative thickness after DMEK is less than anticipated, laser enhancements might not be an option. There's a pressing need for more controlled and randomized clinical trials to ascertain the safety and effectiveness of Premium-IOLs for FECD eyes. This narrative review aims to collate evidence on the use of Premium IOL technologies in eyes receiving EK and to underscore key points for surgeons performing EK combined with cataract surgery.
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Affiliation(s)
- Marina Rodríguez-Calvo-de-Mora
- Qvision, Department of Ophthalmology of VITHAS Almería Hospital, Almería, 04120, Spain
- Ophthalmology Department, VITHAS Málaga, Málaga, 29016, Spain
- Hospital Regional Universitario de Málaga, Plaza del Hospital Civil, S/N, Málaga, 29009, Spain
| | - Carlos Rocha-de-Lossada
- Qvision, Department of Ophthalmology of VITHAS Almería Hospital, Almería, 04120, Spain
- Ophthalmology Department, VITHAS Málaga, Málaga, 29016, Spain
- Hospital Regional Universitario de Málaga, Plaza del Hospital Civil, S/N, Málaga, 29009, Spain
- Departamento de Cirugía, Área de Oftalmología, Universidad de Sevilla, Doctor Fedriani, S/N, Seville, 41009, Spain
| | - Vito Romano
- Ophthalmic Unit, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
- Ophthalmic Unit, ASST Spedali Civili di Brescia, Brescia, Italy
| | | | - Joaquín Fernández
- Qvision, Department of Ophthalmology of VITHAS Almería Hospital, Almería, 04120, Spain
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Ali M, Cho K, Srikumaran D. Fuchs Dystrophy and Cataract: Diagnosis, Evaluation and Treatment. Ophthalmol Ther 2023; 12:691-704. [PMID: 36637659 PMCID: PMC10011243 DOI: 10.1007/s40123-022-00637-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 12/07/2022] [Indexed: 01/14/2023] Open
Abstract
Corneal endothelium plays an important role in maintaining hydration homeostasis and clarity of the cornea. Fuchs endothelial corneal dystrophy (FECD) affects the corneal endothelium resulting in edema and characteristic excrescences on the Descemet's membrane known as corneal guttae. Descemet membrane endothelial keratoplasty (DMEK) has evolved to become the standard of care for patients with FECD with excellent visual acuity outcomes. Patients with FECD may have coexisting cataracts and therefore may require a cataract surgery, which increases the risk of corneal decompensation. The presence of FECD may not only influence the choice of intraocular lens but vision outcomes can also be affected by the corneal condition. The ability to combine the surgeries further raises important considerations regarding the timing and sequence of DMEK and cataract extraction for patients with FECD. This review provides a guide for corneal surgeons in choosing between endothelial keratoplasty and cataract surgery-alone, in combination or sequential-in their management of patients with FECD.
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Affiliation(s)
- Muhammad Ali
- Vice Chair for Education, Wilmer Eye Institute, Johns Hopkins University, Baltimore, MD, USA
| | - Kyongjin Cho
- Vice Chair for Education, Wilmer Eye Institute, Johns Hopkins University, Baltimore, MD, USA
| | - Divya Srikumaran
- Vice Chair for Education, Wilmer Eye Institute, Johns Hopkins University, Baltimore, MD, USA.
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Singh P, Sinha A, Nagpal R, Chaurasia S. Descemet membrane endothelial keratoplasty: Update on preoperative considerations, surgical techniques, and outcomes. Indian J Ophthalmol 2022; 70:3222-3238. [PMID: 36018091 DOI: 10.4103/ijo.ijo_2933_21] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Descemet membrane endothelial keratoplasty (DMEK) is the closest to the physiological replacement of endothelial cells. In the initial years, the technique was surgically challenging. Over the years, with better understanding and modifications in the surgical steps, the technique has evolved as an alternative to more popular procedure Descemet stripping endothelial keratoplasty. The article highlights the various preoperative, intraoperative, and postoperative nuances of DMEK. Additionally, it summarizes the various comparative and noncomparative studies on DMEK outcomes.
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Affiliation(s)
- Prabhakar Singh
- Department of Cornea and Anterior Segment, All India Institute of Medical Sciences, Patna, Bihar, India
| | - Akanksha Sinha
- Cornea and Anterior Segment, Sankara Eye Hospital, Kanpur, Uttar Pradesh, India
| | - Ritu Nagpal
- Research Officer, All India Institute of Medical Sciences, New Delhi, India
| | - Sunita Chaurasia
- Cornea and Anterior Segment Services, L V Prasad Eye Institute, Hyderabad, Telangana, India
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Semler-Collery A, Bloch F, Hayek G, Goetz C, Perone JM. Comparison of triple-DMEK to pseudophakic-DMEK: A cohort study of 95 eyes. PLoS One 2022; 17:e0267940. [PMID: 35551322 PMCID: PMC9098022 DOI: 10.1371/journal.pone.0267940] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 04/20/2022] [Indexed: 11/19/2022] Open
Abstract
Previous comparative studies show that triple Descemet membrane endothelial keratoplasty (DMEK) (i.e. phacoemulsification followed immediately by DMEK) has either equivalent or better visual outcomes than DMEK in pseudophakic patients. To resolve this discrepancy, a retrospective cohort study was conducted. All consecutive patients with Fuchs Endothelial Corneal Dystrophy who underwent triple or pseudophakic DMEK in 2015–2019 in a tertiary-care hospital (France) and were followed for >12 months were compared in terms of best spectacle-corrected visual acuity (BSCVA), final refractive outcomes, and endothelial-cell loss at 12 months as well as rebubbling rates. The triple-DMEK (40 eyes, 34 patients) and pseudophakic-DMEK (55 eyes, 43 patients) groups were similar in terms of age and other baseline variables. They also did not differ in final BSCVA (both 0.03 logMAR), final endothelial-cell loss (54% vs. 48%), or astigmatism (-1.25 vs. -1 D). At 12 months, triple-DMEK associated with significantly smaller residual hyperopia (0.75 vs. 1 D; p = 0.04) and spherical equivalence (0 vs. 0.5 D; p = 0.02). Triple-DMEK also tended to associate with more frequent rebubbling (40% vs. 24%, p = 0.09). In conclusion, while triple-DMEK and pseudophakic-DMEK achieved similar visual acuity improvement, triple-DMEK was superior in terms of final sphere and spherical refraction but also tended to have higher complication rates.
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Affiliation(s)
- Axelle Semler-Collery
- Ophthalmology Department, Mercy Hospital, Metz-Thionville Regional Hospital Center, Metz, France
| | - Florian Bloch
- Ophthalmology Department, Mercy Hospital, Metz-Thionville Regional Hospital Center, Metz, France
| | - George Hayek
- Ophthalmology Department, Mercy Hospital, Metz-Thionville Regional Hospital Center, Metz, France
| | - Christophe Goetz
- Research Support Unit, Mercy Hospital, Metz-Thionville Regional Hospital Center, Metz, France
| | - Jean Marc Perone
- Ophthalmology Department, Mercy Hospital, Metz-Thionville Regional Hospital Center, Metz, France
- Institut Jean Lamour, Team 404, UMR 7198 Nanomaterials and Health, Lorraine University, Nancy, France
- * E-mail:
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Moshirfar M, Huynh R, Ellis JH. Cataract surgery and intraocular lens placement in patients with Fuchs corneal dystrophy: a review of the current literature. Curr Opin Ophthalmol 2022; 33:21-27. [PMID: 34743088 DOI: 10.1097/icu.0000000000000816] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Late-onset Fuchs endothelial corneal dystrophy (FECD) is seen in approximately 4% of individuals over the age of 40. With the growing population of adults over the age of 65, ophthalmologists need to be aware of the preoperative, perioperative, and postoperative considerations involved in cataract surgery in Fuchs patients. RECENT FINDINGS Management of cataract patients with FECD requires preoperative assessment of endothelial cell size, density, and morphology. Considerations for perioperative endothelial cell loss include patients with hyperopia and shallow anterior chambers, phacoemulsification technique, transfer of ultrasonic energy to the cornea, corneal-protective perioperative agents, as well as thermal and mechanical damage. SUMMARY Ophthalmologists performing cataract surgery on patients with FECD must carefully consider the risks of endothelial cell loss during surgery and minimize the risk of corneal decompensation after surgery. Preoperative management should evaluate the severity of the FECD as well as individual factors such as cataract density, the health and thickness of the cornea, and the anterior chamber depth. Perioperative techniques, adjustments to biometry calculations, and intraocular lens (IOL) selection may help optimize visual outcomes and recovery time.
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Affiliation(s)
- Majid Moshirfar
- Hoopes Vision Research Center, Hoopes Vision, Draper, Utah, USA
- John A. Moran Eye Center, Department of Ophthalmology and Visual Sciences, University of Utah, Salt Lake City, Utah, USA
- Utah Lions Eye Bank, Murray, Utah, USA
| | - Rachel Huynh
- University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - James H Ellis
- University of Utah School of Medicine, Salt Lake City, Utah, USA
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Hussien AMRM, Elmassry A, Ghaith AA, Goweida MBB. Descemet's Membrane Endothelial Keratoplasty and Phacoemulsification: Combined versus Sequential Surgery. J Curr Ophthalmol 2021; 33:277-284. [PMID: 34765815 PMCID: PMC8579805 DOI: 10.4103/joco.joco_188_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 01/25/2021] [Accepted: 02/06/2021] [Indexed: 11/24/2022] Open
Abstract
Purpose: To compare the outcomes of Descemet's membrane endothelial keratoplasty (DMEK) combined with phacoemulsification versus DMEK following phacoemulsification. Methods: In this interventional retrospective comparative nonrandomized case series study, patients with Fuchs endothelial corneal dystrophy (FECD) with either cataract or previous cataract surgery with intraocular lens (IOL) implantation were assigned to one of the two groups according to lens status. Group 1 included patients who had cataract and FECD and would undergo triple procedure (phacoemulsification with IOL implantation and DMEK), whereas Group 2 included patients who had FECD and had phacoemulsification with IOL implantation earlier and would undergo DMEK only as a sequential procedure. Results: Postoperative best corrected visual acuity (BCVA) in both groups at 1 week, 1 month, 3 months, and 6 months revealed a statistically nonsignificant difference between the two groups with mean logMAR BCVA at 6 months of 0.07 ± 0.18 and 0.07 ± 0.19 in Group 1 and Group 2, respectively (P > 0.05). The drop in endothelial cell density by the end of the 6th postoperative month was by 39.44% ±7.92 and 38.73% ±8.10 in the triple-procedure group and DMEK only group, respectively (P = 0.005). Total postoperative complications rate and the rebubbling rate were statistically similar between both groups with 13.5% and 12.5% rebubbling rate in Group 1 and Group 2, respectively (P > 0.05). Conclusion: Visual outcomes, endothelial cell loss, and rebubbling rate are comparable when DMEK is combined with phacoemulsification or when it is performed as staged procedure, without statistically significant difference in the outcomes.
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Affiliation(s)
- Ahmed Mahmoud Ragab Mahmoud Hussien
- Department of Ophthalmology, Faculty of Medicine, Alexandria University, Alexandria, Egypt.,Department of Ophthalmology, Torbay and South Devon NHS Trust, Torquay, UK
| | - Ahmed Elmassry
- Department of Ophthalmology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Alaa Atef Ghaith
- Department of Ophthalmology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
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Moshiri I, Karimi-Golkar D, Schrittenlocher S, Cursiefen C, Bachmann B. Outcomes of Pseudophakic, Phakic, and Triple DMEK. Cornea 2021; 40:1253-1257. [PMID: 33859090 DOI: 10.1097/ico.0000000000002723] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 02/07/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate the outcome of phakic and pseudophakic eyes treated by Descemet membrane endothelial keratoplasty (DMEK) versus DMEK combined with cataract surgery (triple DMEK). METHODS Retrospective cohort study based on the prospective Cologne DMEK data base. This study is a single-center analysis of 62 eyes undergoing phakic (age mean ± SD 52 ± 6.43), 518 eyes undergoing pseudophakic (73.5 ± 8.57), and 557 eyes undergoing triple DMEK (67.93 ± 8.57). Outcome measures were changes in best spectacle-corrected visual acuity (BSCVA), central corneal thickness, endothelial cell density (ECD), rebubbling rates within the first year after surgery, and the need for cataract surgery within the first 2 years after phakic DMEK. RESULTS The preoperative BSCVA (mean ± SD; logarithm of the minimum angle of resolution) was 0.30 ± 0.22 in the phakic, 0.63 ± 0.45 in the pseudophakic, and 0.44 ± 0.30 in the triple DMEK group (P < 0.001), which changed to 0.09 ± 0.12, 0.14 ± 0.1, and 0.1 ± 0.1 (P < 0.001) 1 year after surgery, respectively. There was no difference in central corneal thickness (P = 0.929) and endothelial cell density (P = 0.606) 1 year postoperatively. Rebubbling rates in DMEK using SF6 20% for anterior chamber tamponade were not significantly different (P = 0.839). After phakic DMEK, 40% of eyes underwent cataract surgery within the second year. However, there was a high loss to follow-up in this group. CONCLUSIONS Phakic and triple DMEK procedures tend to have a better 1-year BSCVA than pseudophakic DMEK, with no differences in all other parameters analyzed. However, patients from the pseudophakic DMEK group were older and already had worse BSCVA before surgery.
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Affiliation(s)
- Isabella Moshiri
- Department of Ophthalmology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
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Vasiliauskaitė I, Dhubhghaill SN, Ham L, Van Dijk K, Oellerich S, Melles GRJ. Phacoemulsification After Descemet Membrane Endothelial Keratoplasty: Incidence and Influence on Endothelial Cell Density. J Refract Surg 2021; 37:119-125. [PMID: 33577698 DOI: 10.3928/1081597x-20201208-01] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 11/13/2020] [Indexed: 11/20/2022]
Abstract
PURPOSE To analyze the incidence of cataract extraction after Descemet membrane endothelial keratoplasty (DMEK) in phakic eyes and to evaluate the effect of phacoemulsification after DMEK on the donor endothelial cell density (ECD). METHODS The clinical data of phakic patients with DMEK were examined. From this cohort, all patients who subsequently underwent phacoemulsification after DMEK were reviewed. Data from a prospectively collected dataset were analyzed, including demographic profile, ECD, corrected distance visual acuity (CDVA), central corneal thickness (CCT), and complications. RESULTS From a series of 261 phakic patients with DMEK, 35 eyes (13.4%) required cataract surgery within the mean follow-up period of 54.2 ± 28 months. The mean time from DMEK to phacoemulsification was 18 ± 13 months (range: 3 to 69 months). The probability of cataract extraction after DMEK was 0.06 (95% CI: 0.03 to 0.09) at 1 year and 0.17 (95% CI: 0.12 to 0.22) at 10 years, respectively. ECD decreased from 1,314 ± 524 cells/mm2 before phacoemulsification to 1,167 ± 443 cells/mm2 (-11%) at 1 to 6 months postoperatively (P = .333). CDVA improved from 0.27 ± 0.13 logMAR preoperatively to 0.07 ± 0.12 logMAR at 1 to 6 months postoperatively. CCT before phacoemulsification was 532 ± 46 µm and remained stable at 539 ± 56 µm at 1 to 6 months after phacoemulsification. Phacoemulsification did not elicit DMEK graft detachment in any of the eyes studied. CONCLUSIONS The incidence and 10-year projection of cataract extraction in phakic eyes with DMEK was relatively low. Phacoemulsification after DMEK provided excellent CDVA outcomes, did not induce graft detachment, and was associated with an acceptable decrease in ECD. [J Refract Surg. 2021;37(2):119-125.].
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Kam YW, Ramirez DA, Ling JJ, Greiner MA, Sales CS. Performing DMEK with Other Surgical Procedures: Staged vs. Combined Approaches in Straightforward Cases. CURRENT OPHTHALMOLOGY REPORTS 2021. [DOI: 10.1007/s40135-021-00264-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Boutillier G, Bernheim D, Denoyer A, Gabison E, Sitbon C, Hacquard M, Muraine M. Refractive accuracy and visual outcomes after combined descemet membrane endothelial keratoplasty and cataract surgery: A French multicentric study. J Fr Ophtalmol 2021; 44:792-798. [PMID: 34049717 DOI: 10.1016/j.jfo.2020.06.052] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 06/16/2020] [Accepted: 06/18/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE Descemet membrane endothelial keratoplasty (DMEK) combined with cataract extraction and intraocular lens insertion (new triple procedure) limits postoperative refractive errors. The objective of this study was to assess refractive accuracy after DMEK combined with cataract extraction and intraocular lens implantation. SETTING Four university hospitals (Rouen, Paris, Reims, Grenoble). DESIGN This retrospective multicenter study included patients with symptomatic corneal endothelial decompensation and cataract. METHODS The primary outcome was the difference between the target spherical equivalent and postoperative refraction at months 2 and 6. Secondary outcomes were visual acuity, keratometry, pachymetry and endothelial cell density. RESULTS A total of 130 eyes of 111 patients (mean age 66.2 years) were included (94% with Fuchs' endothelial dystrophy). For a mean refractive target set at -0.50 (±0.57) D, the mean (95% CI) refractive error was hyperopia of +0.49 (0.314; 0.664) D at 2 months and +0.46 (0.299; 0.619) D at 6 months. Best corrected distance visual acuity was improved in all patients: from 0.49 (±0.3) logMAR to 0.14 (±0.14) logMAR at 2 months and 0.05 (±0.1) logMAR at 6 months. Mean corneal thickness decreased from 621.6 (±37.6) μm to 515.2 (±42.6) μm at 2 months and 539.0 (±39.0) μm at 6 months. CONCLUSIONS Good refractive accuracy was obtained after the new triple procedure with DMEK. Hyperopic shift is common after triple procedures, and its persistence should be evaluated in future studies in order to anticipate a change in its value to optimize intraocular lens power calculation.
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Affiliation(s)
- G Boutillier
- Department of Ophthalmology, Rouen University Hospital, 1, Rue de Germont, 76031 Rouen cedex, France.
| | - D Bernheim
- Department of Ophthalmology, Grenoble University Hospital, Avenue Maquis du Grésivaudan, 38700 La Tronche, France
| | - A Denoyer
- Department of Ophthalmology, Reims University Hospital, Rue du Général Koenig, 51100, Reims, France
| | - E Gabison
- Department of Ophthalmology, Fondation Rothschild, Paris University Hospital, 44, Avenue Mathurin Moreau, 75019 Paris, France
| | - C Sitbon
- Department of Ophthalmology, Fondation Rothschild, Paris University Hospital, 44, Avenue Mathurin Moreau, 75019 Paris, France
| | - M Hacquard
- Department of Ophthalmology, Grenoble University Hospital, Avenue Maquis du Grésivaudan, 38700 La Tronche, France
| | - M Muraine
- Department of Ophthalmology, Rouen University Hospital, 1, Rue de Germont, 76031 Rouen cedex, France
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Eisenbeisz HC, Bleeker AR, Terveen DC, Berdahl JP. Descemet Membrane Endothelial Keratoplasty and light adjustable lens triple procedure. Am J Ophthalmol Case Rep 2021; 22:101061. [PMID: 33718662 PMCID: PMC7933706 DOI: 10.1016/j.ajoc.2021.101061] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 02/08/2021] [Accepted: 02/21/2021] [Indexed: 11/19/2022] Open
Abstract
Purpose The objective of this series is to report the early post-operative visual outcomes of a novel triple procedure utilizing Descemet membrane endothelial keratoplasty (DMEK) plus light adjustable lens (LAL) in two patients (four eyes). Methods Two patients with bilateral, visually significant cataracts and Fuchs' dystrophy were selected for DMEK plus LAL triple procedure. Patient B also exhibited a high amount of preoperative astigmatism. Both patients desired spectacle independence and were initially targeted for monovision with the dominant eye corrected for distance and the nondominant eye corrected for near. Best corrected visual acuity (BCVA), uncorrected visual acuity (UCVA), and manifest refraction were recorded at each postoperative appointment and light treatment. Results In the early post-operative course, Patient A chose to pursue binocular distance correction instead of monovision. This was adjusted for accordingly using the LAL. Following final lock-in, Patient A had a distance UCVA of 20/15 in the right eye (OD) and a distance UCVA of 20/20 in the left eye (OS). Patient B was targeted for monovision. After final lock-in, Patient B had a distance UCVA of 20/15 in the dominant eye (OD) and a near UCVA of Jaeger No. 1+ in the nondominant eye (OS). Conclusions and Importance The first reported cases of DMEK plus LAL triple procedures achieved exceptional UCVA at the desired target. The post-operative customizability of the LAL allows for the achievement of excellent refractive outcomes after DMEK, even in patients with significant astigmatism and in patients who change their mind regarding refractive target.
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Affiliation(s)
- H. Carson Eisenbeisz
- University of South Dakota Sanford School of Medicine, 1400 W. 22 St., Sioux Falls, SD, 57105, USA
- Corresponding author. 520 Kansas City St. Suite 200, Rapid City, SD, 57701, USA.
| | - Adam R. Bleeker
- University of South Dakota Sanford School of Medicine, 1400 W. 22 St., Sioux Falls, SD, 57105, USA
| | - Daniel C. Terveen
- University of South Dakota Sanford School of Medicine, 1400 W. 22 St., Sioux Falls, SD, 57105, USA
- Vance Thompson Vision, 3101 West 57 St., Sioux Falls, SD, 57108, USA
| | - John P. Berdahl
- University of South Dakota Sanford School of Medicine, 1400 W. 22 St., Sioux Falls, SD, 57105, USA
- Vance Thompson Vision, 3101 West 57 St., Sioux Falls, SD, 57108, USA
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Shajari M, Kolb CM, Mayer WJ, Agha B, Steinwender G, Dirisamer M, Priglinger S, Kohnen T, Schmack I. Characteristics of preoperative and postoperative astigmatism in patients having Descemet membrane endothelial keratoplasty. J Cataract Refract Surg 2020; 45:1001-1006. [PMID: 31262462 DOI: 10.1016/j.jcrs.2019.02.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 01/07/2019] [Accepted: 02/01/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE To evaluate the characteristics of preoperative and postoperative astigmatism in patients having Descemet membrane endothelial keratoplasty (DMEK). SETTING Department of Ophthalmology, Goethe University, Frankfurt, Germany. DESIGN Retrospective case series. METHODS Measurements were obtained using a Scheimpflug camera (Pentacam AXL) preoperatively and 3 months and 12 months postoperatively. Values of front and back astigmatism and total astigmatism in the central 4.0 mm diameter zone (TCA4) were analyzed. RESULTS Fifty-three eyes of 45 patients were included. The prevalence of TCA4 above 1.0 diopter (D) was considerably higher (79%) and with-the-rule astigmatism was less frequent in this cohort of European patients with Fuchs endothelial dystrophy (mean age 65 years) than that reported in a meta-analysis of healthy European eyes. The TCA4 values correlated with anterior astigmatism preoperatively and postoperatively (P < .001) and with posterior astigmatism at the 1-year follow-up (P < .01). Although, no correlation was found between the preoperative and 1-year results for anterior astigmatism (P = .12), posterior astigmatism (P = .35), or total corneal astigmatism (P = .47), the difference in vector analysis between the two measurements was only 0.01 at 109 degrees, 0.03 at 98 degrees, and 0.02 at 157 degrees, respectively. However, the greater the difference between the preoperative TCA3 and preoperative TCA5 values, the greater the decrease in corneal astigmatism (P < .001). CONCLUSIONS The percentage of eyes with corneal astigmatism above 1.0 D was higher preoperatively and postoperatively in patients with Fuchs endothelial dystrophy than in a healthy population. Predicting postoperative astigmatism based on preoperative results is not possible; however, in eyes with a high difference between TCA3 and TCA5, a reduction in corneal astigmatism after DMEK is likely.
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Affiliation(s)
- Mehdi Shajari
- Department of Ophthalmology, Goethe-University, Frankfurt, Germany; Department of Ophthalmology, LM-University, Munich, Germany
| | - Carolin M Kolb
- Department of Ophthalmology, Goethe-University, Frankfurt, Germany
| | | | - Bishr Agha
- Department of Ophthalmology, Goethe-University, Frankfurt, Germany
| | | | | | | | - Thomas Kohnen
- Department of Ophthalmology, Goethe-University, Frankfurt, Germany.
| | - Ingo Schmack
- Department of Ophthalmology, Goethe-University, Frankfurt, Germany
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Birbal RS, Baydoun L, Ham L, Miron A, van Dijk K, Dapena I, Jager MJ, Böhringer S, Oellerich S, Melles GRJ. Effect of Surgical Indication and Preoperative Lens Status on Descemet Membrane Endothelial Keratoplasty Outcomes. Am J Ophthalmol 2020; 212:79-87. [PMID: 31863726 DOI: 10.1016/j.ajo.2019.12.011] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 12/09/2019] [Accepted: 12/11/2019] [Indexed: 12/27/2022]
Abstract
PURPOSE To analyze 6-month results of 1000 consecutive Descemet membrane endothelial keratoplasty (DMEK) cases, and to evaluate if outcomes are influenced by surgical indication and preoperative lens status. DESIGN Retrospective, interventional case series. METHODS A series of 1000 eyes (738 patients) underwent DMEK mainly for Fuchs endothelial corneal dystrophy (FECD; 85.3%) or bullous keratopathy (BK; 10.5%). Main outcome measures were best-corrected visual acuity (BCVA), endothelial cell density, postoperative complications, and retransplantations. RESULTS At 6 months after DMEK, there was no difference in BCVA outcome between FECD and BK eyes (P = .170), or between phakic and pseudophakic FECD eyes (P = .066) after correcting for patient age and preoperative BCVA. Endothelial cell loss at 6 months postoperatively was similar for phakic and pseudophakic FECD eyes (39%; P = .852), but higher for BK eyes than for FECD eyes (46% vs 39%, P = .001). Primary and secondary graft failure occurred in 3 (0.3%) and 2 eyes (0.2%), respectively, and 7 eyes developed allograft rejection (0.7%). Eighty-two eyes (8.2%) received rebubbling for graft detachment and retransplantation was performed in 20 eyes (2.0%). Rebubbling was more often required in eyes treated for BK vs FECD eyes (12.4% vs 7.4%, P = .022). CONCLUSION DMEK consistently provides excellent short-term results, with similar high visual acuity levels for both FECD and BK eyes. As preoperative lens status did not influence DMEK outcomes, for phakic FECD eyes with a still relatively clear crystalline lens, lens preservation may be preferable in a selected group of younger patients, who may still benefit from their residual accommodative capacity.
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Affiliation(s)
- Rénuka S Birbal
- Netherlands Institute for Innovative Ocular Surgery (NIIOS), Rotterdam, Netherlands; Melles Cornea Clinic Rotterdam, Rotterdam, Netherlands; Amnitrans Eye Bank Rotterdam, Rotterdam, Netherlands
| | - Lamis Baydoun
- Netherlands Institute for Innovative Ocular Surgery (NIIOS), Rotterdam, Netherlands; Melles Cornea Clinic Rotterdam, Rotterdam, Netherlands; Department of Ophthalmology, University Hospital Münster, Münster, Germany
| | - Lisanne Ham
- Netherlands Institute for Innovative Ocular Surgery (NIIOS), Rotterdam, Netherlands; Melles Cornea Clinic Rotterdam, Rotterdam, Netherlands; Amnitrans Eye Bank Rotterdam, Rotterdam, Netherlands
| | - Alina Miron
- Netherlands Institute for Innovative Ocular Surgery (NIIOS), Rotterdam, Netherlands; Melles Cornea Clinic Rotterdam, Rotterdam, Netherlands
| | - Korine van Dijk
- Netherlands Institute for Innovative Ocular Surgery (NIIOS), Rotterdam, Netherlands; Melles Cornea Clinic Rotterdam, Rotterdam, Netherlands
| | - Isabel Dapena
- Netherlands Institute for Innovative Ocular Surgery (NIIOS), Rotterdam, Netherlands; Melles Cornea Clinic Rotterdam, Rotterdam, Netherlands
| | - Martine J Jager
- Department of Ophthalmology, Leiden University Medical Center, Leiden, Netherlands
| | - Stefan Böhringer
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, Netherlands
| | - Silke Oellerich
- Netherlands Institute for Innovative Ocular Surgery (NIIOS), Rotterdam, Netherlands
| | - Gerrit R J Melles
- Netherlands Institute for Innovative Ocular Surgery (NIIOS), Rotterdam, Netherlands; Melles Cornea Clinic Rotterdam, Rotterdam, Netherlands; Amnitrans Eye Bank Rotterdam, Rotterdam, Netherlands; NIIOS-USA, San Diego, California, USA.
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Hsu SL, Lee PY, Chiu LY. A simple method for preventing graft detachment during phacoemulsification cataract surgery after Descemet stripping automated endothelial keratoplasty: A case report. Medicine (Baltimore) 2019; 98:e13992. [PMID: 30633183 PMCID: PMC6336656 DOI: 10.1097/md.0000000000013992] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Graft detachment and endothelial cell damages are 2 major concerns for cataract surgeries in cases after Descemet stripping automated endothelial keratoplasty (DSAEK). We invented a simple but innovative method to anchor the DSAEK graft with sutures during the surgery to avoid possible graft detachment. PATIENT CONCERNS We present a 59-year-old male who had done DSAEK surgery. Due to progressed blurry vision due to cataract, he underwent sequential cataract surgery 1 year after DSAEK surgery. We applied the method to the patient successfully and the result was satisfying. DIAGNOSIS Cataract post-DSAEK surgery. INTERVENTIONS At the beginning of surgery, we made 4 radial fixation sutures with Nylon 10-0 though cornea-DSAEK graft at paracentral point and then through limbus. The sutures were located at 45°, 135°, 225°, and 315°. At the end of surgery, 4 fixation sutures were removed. OUTCOMES The DSAEK graft was kept well attached during and after the surgery. Only low-grade corneal edema was found postoperation. LESSONS We provide this special method and applied it to our patient successfully. By using our method, surgeons can reassure graft adhesion during and after surgery, especially for those need cataract surgery after DSAEK surgery.
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Santander-García D, Dapena I, Baydoun L, Melles GRJ. DMEK complications: current treatment and recommendations. EXPERT REVIEW OF OPHTHALMOLOGY 2018. [DOI: 10.1080/17469899.2018.1429917] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Diana Santander-García
- Netherlands Institute for Innovative Ocular Surgery, Rotterdam, The Netherlands
- Melles Cornea Clinic Rotterdam, Rotterdam, The Netherlands
| | - Isabel Dapena
- Netherlands Institute for Innovative Ocular Surgery, Rotterdam, The Netherlands
- Melles Cornea Clinic Rotterdam, Rotterdam, The Netherlands
| | - Lamis Baydoun
- Netherlands Institute for Innovative Ocular Surgery, Rotterdam, The Netherlands
- Melles Cornea Clinic Rotterdam, Rotterdam, The Netherlands
| | - Gerrit R. J. Melles
- Netherlands Institute for Innovative Ocular Surgery, Rotterdam, The Netherlands
- Melles Cornea Clinic Rotterdam, Rotterdam, The Netherlands
- Amnitrans Eye Bank Rotterdam, Rotterdam, The Netherlands
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Beltz J, Madi S, Nahum Y, Santorum P, Busin M. Descemet stripping automated endothelial keratoplasty in phakic eyes: incision modification reducing cataract formation. Int J Ophthalmol 2018; 11:53-57. [PMID: 29375991 DOI: 10.18240/ijo.2018.01.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Accepted: 09/04/2017] [Indexed: 11/23/2022] Open
Abstract
AIM To evaluate the efficacy of a technical modification to reduce the incidence of traumatic cataract induced by Descemet stripping automated endothelial keratoplasty (DSAEK) performed in phakic eyes. METHODS A retrospective cohort study. The records of all patients with a clear crystalline lens and endothelial failure that underwent modified DSAEK at our insitution were reviewed. In this modification, in order to avoid inadvertent touch of the insertion forceps against the exposed crystalline lens while passing across the anterior chamber, the incision sites were shifted from the standard 9 and 3 o'clock positions, superiorly to the 10 and 2 o'clock position respectively. Formation of typically traumatic, anterior subcapsular cataract in these patients was compared to that observed in a cohort including all the patients with a clear crystalline lens and endothelial failure that underwent conventional DSAEK at our institution. RESULTS The study group included 49 eyes following modified DSAEK and the control group included 35 eyes following DSAEK with conventional incision sites. Anterior subcapsular cataract occurring 4mo or less postoperatively was identified in 2 of 49 (4%) eyes in the study group and 7 of 35 (20%) eyes in the control group. The rates of traumatic cataract were significantly higher in the control group in comparison to the study group (P=0.03, RR=4.9, 95%CI 1.08-22.1). CONCLUSION Traumatic cataract formation following phakic DSAEK may be avoided with a simple modification to the position of the incision sites.
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Affiliation(s)
- Jacqueline Beltz
- Department of Ophthalmology, Villa Igea Private Hospital, Forlì 47122, Italy.,Istituto Internazionale per la Ricerca e Formazione in Oftalmologia (IRFO), Forlì 47122, Italy.,Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne 3002, Australia
| | - Silvana Madi
- Department of Ophthalmology, Villa Igea Private Hospital, Forlì 47122, Italy.,Istituto Internazionale per la Ricerca e Formazione in Oftalmologia (IRFO), Forlì 47122, Italy.,Department of Ophthalmology, Alexandria University Hospital, Alexandria 21527, Egypt
| | - Yoav Nahum
- Department of Ophthalmology, Villa Igea Private Hospital, Forlì 47122, Italy.,Istituto Internazionale per la Ricerca e Formazione in Oftalmologia (IRFO), Forlì 47122, Italy.,Department of Ophthalmology, Rabin Medical Center, Petah Tikva 49100, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Paolo Santorum
- Department of Ophthalmology, Villa Igea Private Hospital, Forlì 47122, Italy.,Istituto Internazionale per la Ricerca e Formazione in Oftalmologia (IRFO), Forlì 47122, Italy.,Department of Ophthalmology, San Maurizio Regional Hospital, Bolzano 39100, Italy
| | - Massimo Busin
- Department of Ophthalmology, Villa Igea Private Hospital, Forlì 47122, Italy.,Istituto Internazionale per la Ricerca e Formazione in Oftalmologia (IRFO), Forlì 47122, Italy.,Department of Morphology, Surgery and Experimental Surgery, University of Ferrara, Ferrara 44100, Italy
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Abstract
Endothelial keratoplasty (EK) has revolutionized corneal transplant surgery by providing rapid visual recovery and improved visual outcomes. In parts of the world with Fuchs endothelial dystrophy, many patients may present with both cataracts and corneal degeneration requiring surgery. Other forms of endothelial decompensation may also present with cataracts. The staging or combination of transplant surgery and cataract surgery depend on both the abilities of the surgeon and the surgical techniques being considered. We currently use phacoemulsification to remove cataracts and routinely perform both cataract surgery and EK with topical anesthesia. The decision to perform either combined or staged cataract and transplant surgery depends upon the examination of the eye including assessment of the anterior chamber depth and the status of the anterior surface of the cornea, which affects the ability to reliably assess keratometry. Additional considerations include the type of lens implant to use, the desired refractive outcome, and the patient's preference about whether to undergo 1 or 2 surgical procedures per eye.
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Abstract
PURPOSE OF REVIEW Descemet membrane endothelial keratoplasty (DMEK) has become a first-line treatment in corneal endothelial diseases because of its exceptional clinical outcomes and low complication rates. Because of its improved refractive predictability, DMEK is now also considered for managing cases with endothelial decompensation following previous refractive procedures, or in combination with those. This article reviews the clinical outcomes in these cases and discusses the possibility of refractive interventions following DMEK. RECENT FINDINGS DMEK has been successfully performed in eyes after laser in-situ keratomileusis, eyes after anterior chamber intraocular lens (IOL) implantation and aphakic eyes. Often, DMEK is combined with cataract surgery (triple-DMEK). Initial reports on reducing the refractive cylinder by toric IOL implantation are available. Although there are some reports on phacoemulsification and IOL implantation after phakic DMEK, reports on laser refractive procedures following DMEK are lacking. SUMMARY In contrast to earlier keratoplasty techniques, DMEK induces on average only mild refractive shifts owing to the 'natural' restoration of the cornea. As such, DMEK may be ideal in managing corneal decompensation in refractive patients. However, further studies are required to assess the safety and efficacy of DMEK after refractive treatment and of refractive procedures following DMEK.
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Girbardt C, Wiedemann P, Nestler A. [Triple Descemet membrane endothelial keratoplasty. Indications, variations and results]. Ophthalmologe 2016; 113:213-6. [PMID: 26857142 DOI: 10.1007/s00347-016-0219-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
When Descemet membrane endothelial keratoplasty (DMEK) is indicated in patients with phakic eyes, a combination with phacoemulsification and intraocular lens implantation in one sitting should be considered as a triple DMEK. The best possible preoperative deswelling of the cornea should be strived for in order to allow sufficient viewing conditions for the individual stages of cataract surgery. Furthermore, technical details, e.g. regulation of pupillary width also must be considered. The power of the intraocular lens has to be adjusted in order to compensate for the shift of refraction towards hyperopic values induced by DMEK surgery. A rapid and clear improvement in visual acuity can normally be achieved after a triple DMEK. There seem to be no disadvantages compared with a two-stage procedure for DMEK and cataract surgery.
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Affiliation(s)
- C Girbardt
- Klinik und Poliklinik für Augenheilkunde, Universitätsklinikum Leipzig, Liebigstraße 10-14, 04103, Leipzig, Deutschland.
| | - P Wiedemann
- Klinik und Poliklinik für Augenheilkunde, Universitätsklinikum Leipzig, Liebigstraße 10-14, 04103, Leipzig, Deutschland
| | - A Nestler
- Klinik und Poliklinik für Augenheilkunde, Universitätsklinikum Leipzig, Liebigstraße 10-14, 04103, Leipzig, Deutschland
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Konder R, Baydoun L, Dirisamer M, Ciechanowski P, Oellerich S, Melles G. Descemet Membran Endothelkeratoplastik (DMEK) und/oder Phakoemulsifikation in phaken Augen mit Hornhautendotheldystrophie. SPEKTRUM DER AUGENHEILKUNDE 2015. [DOI: 10.1007/s00717-015-0253-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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DMEK in phakic eyes: targeted therapy or highway to cataract surgery? Graefes Arch Clin Exp Ophthalmol 2015; 253:909-14. [DOI: 10.1007/s00417-015-2956-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Revised: 01/20/2015] [Accepted: 01/26/2015] [Indexed: 11/26/2022] Open
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Alio JL, Abdelghany AA, Maldonado MJ. Cataract surgery in cases with previous corneal surgery. EXPERT REVIEW OF OPHTHALMOLOGY 2014. [DOI: 10.1586/17469899.2014.911087] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Burkhart ZN, Feng MT, Price FW, Price MO. One-year outcomes in eyes remaining phakic after Descemet membrane endothelial keratoplasty. J Cataract Refract Surg 2014; 40:430-4. [DOI: 10.1016/j.jcrs.2013.08.047] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2013] [Revised: 08/09/2013] [Accepted: 08/09/2013] [Indexed: 10/25/2022]
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