Simultaneous versus Sequential Phacoemulsification and Descemet Membrane Endothelial Keratoplasty in Patients with Fuch’s Endothelial Dystrophy
Authors: Shaun I. R. Lampen, Stephanie Baxter, Davin E. Johnson.
Disclosure Block: S.I.R. Lampen: None. S. Baxter: None. D.E. Johnson: None.
Abstract Title: Simultaneous versus Sequential Phacoemulsification and Descemet Membrane Endothelial Keratoplasty in Patients with Fuch’s Endothelial Dystrophy
Purpose: To compare the effectiveness of sequential versus combination cataract surgery and Descemets membrane endothelial keratoplasty (DMEK) in patients with Fuch’s endothelial dystrophy.
Study Design: Retrospective chart review.
Methods: The electronic medical records of all patients receiving DMEK for treatment of Fuchs endothelial dystrophy between 2017 and 2019 by 2 surgeons were analyzed. Patients were divided into 3 groups based on the timing of DMEK relative to cataract surgery: planned sequential surgery (cataract surgery followed by DMEK <12 weeks later), unplanned sequential surgery (DMEK >12 weeks after cataract surgery or DMEK following cataract surgery with another ophthalmologist), and combination surgery (cataract surgery and DMEK at the same time). The primary outcomes were the rate of corneal edema resolution at 1 week and 1 month and the postoperative rebubbling rate.
Results: Of the 146 eyes included in the study, 15, 79, and 52 eyes were treated with planned sequential, unplanned sequential, or combination DMEK, respectively. The rate of corneal edema resolution was 57.1%, 15.4%, and 13.5% at week 1 (p < 0.001 between groups) and 85.7%, 58.2%, and 56.9% at month 1 (p = 0.124 between groups) in the planned sequential, unplanned sequential, and combination DMEK, respectively. Post-operative rebubbling rate was 6.7% (95% CI 0.01 - 0.29), 11.4% (95% CI 0.06 - 0.20), and 21.2% (95% CI 0.12 - 0.34) among eyes treated with planned sequential, unplanned sequential, or combination DMEK (p = 0.198 between groups) with a relative risk of 1.99 in combination vs. sequential surgery. There was 1 graft failure in both the unplanned sequential and the combination DMEK group.
Conclusions: In our series a trend towards improved outcomes with DMEK was seen when the keratoplasty was performed following rather than in combination with cataract surgery. Various factors could account for this including intraocular inflammation associated with phacoemulsification and retained viscoelastic material. Although the results were not statistically significant, clinicians should consider the potentially higher risk of graft detachment when offering combination DMEK/cataract surgery for patient convenience.