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Publication Exclusive: Preserving the lens important in young phakic patients undergoing DMEK
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Endothelial keratoplasty, or EK, appears to be the epicenter of the corneal transplantation scene, and it has surpassed penetrating keratoplasty for the surgical correction of endothelial decompensation and corneal edema in the United States. This preferred choice of EK over PK is largely due to the superior quality of vision that returns relatively quickly after EK surgery and the lowest endothelial rejection rate as compared with other forms of corneal transplantation; in addition, the majority of the patient’s own cornea is retained without any full-thickness corneal wound, and the use of conventional sutures, for the most part, is eliminated in EK.
All three segments of ophthalmic surgical care — the patient, the corneal surgeon and industry — have seemed to contribute in a positive way to make EK prominent in the corneal transplantation arena. The patient wishes for a better quality of vision to match an active lifestyle; the surgeon seeks an improved surgical procedure; and industry develops new EK instruments to facilitate the transition from full-thickness surgery to selective tissue corneal transplantation. In addition, eye banks have embraced EK procedures and are providing ready-to-use EK donor tissues for corneal surgeons. These efforts from all sides have helped EK move to the preferred procedure of choice when dealing with endothelial decompensation and corneal edema with or without associated Fuchs’ corneal dystrophy.
Although, most EK procedures are usually performed in the pseudophakic eye, there is a subset of patients with Fuchs’ dystrophy who are phakic with a clear lens and are symptomatic due to endothelial decompensation and require an EK procedure for their visual rehabilitation. Because these patients are young, preservation of the lens and useful accommodation becomes an important factor, and phakic Descemet’s membrane endothelial keratoplasty needs to be considered. It is, however, important to inform the patient about the possibility of lens removal and IOL implantation if there is intraoperative lens damage or postoperative lens clouding.
In this column, I describe the surgical technique of DMEK in a phakic eye and point out some of the surgical pearls to keep in mind while performing this procedure.
Click here to read the full publication exclusive, Surgical Maneuvers, published in Ocular Surgery News U.S. Edition, March 25, 2016.