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Surgeon discourages combining DMEK with phaco
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WARSAW — Phakic eyes fare better than pseudophakic eyes after Descemet’s membrane endothelial keratoplasty, and given the low incidence of induced cataract development, there is no reason to combine DMEK with phaco, according to one surgeon.
Fearing that endothelial grafts may be damaged by postoperative cataract development and subsequent phaco surgery, surgeons sometimes choose to combine the two procedures, Jack Parker, MD, said at the winter meeting of the European Society of Cataract and Refractive Surgeons.
Jack Parker
“Combined procedures are possible but may not be desirable since data seem to suggest that after DMEK, patients do better if their natural lens is left in place. They can read more letters, visual rehabilitation is faster, and they are subjectively happier with their eyesight because they've retained the ability to accommodate,” Parker said.
Data from 106 phakic eyes that underwent DMEK were collected and monitored for an average of 2 years. Five eyes developed cataract requiring phacoemulsification. Uncomplicated phaco surgery was performed in all five eyes, with excellent visual results, Parker said.
“Phacoemulsification may potentially induce detachment by sucking the graft off the posterior corneal surface, but in our eyes this never happened. It appears that this fear is more imaginary than real,” he said.
“We should not engage in combined procedures as a matter of course. We should operate on phakic eyes and leave them phakic. If they develop a cataract … we can deal with that well and safely with a subsequent operation,” Parker said.
Disclosure: Parker has no relevant financial disclosures.