Phacoemulsification After Descemet Membrane Endothelial Keratoplasty: Incidence and Influence on Endothelial Cell Density

PURPOSE: To analyze the incidence of cataract extraction after Descemet membrane endothelial keratoplasty (DMEK) in phakic eyes and to evaluate the effect of phacoemutsification 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 phacoemutsification 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 phacoemutsification was 18 +/- 13 months (range: 3 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/mm(2) before phacoemulsification to 1,167 +/- 443 cells/mm(2) (-11%) at 1 to 6 months postoperatively (P = .333). CDVA improved from 0.27 +/- 0.13 tog MAR preoperatively to 0.07 +/- 0.12 logMAR at 1 to 6 months postoperatively. CCT before phacoemulsification was 532 +/- 46 mu m and remained stable at 539 +/- 56 mu m 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 tow. Phacoemulsification after DMEK provided excellent CDVA outcomes, did not induce graft detachment, and was associated with an acceptable decrease in ECD.

Automated summary

The study analyzed the occurrence of cataract extraction after DMEK in phakic eyes and the impact of phacoemulsification post-DMEK on ECD. Phacoemulsification after DMEK provided good CDVA outcomes, did not cause graft detachment, and led to an acceptable decrease in ECD.