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DMEK prior to cataract surgery shows better results than combined procedure

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CHICAGO — Compared with Descemet’s membrane endothelial keratoplasty combined with cataract surgery, performing cataract surgery after Descemet’s membrane endothelial keratoplasty provides patients with better uncorrected distance visual acuity, no significant increase in endothelial cell loss, and additional beneficial outcomes, according to a speaker here.

A retrospective, single-center case/control study included 35 cataract surgeries staged after DMEK and 85 DMEK triple procedures. Researchers evaluated corrected distance visual acuity, uncorrected distance visual acuity, spherical equivalent, refractive cylinder, and endothelial cell loss after at least 6-months of follow up, Marianne O. Price, PhD, said at the American Academy of Ophthalmology meeting.

At final follow up, 65% of patients who underwent cataract surgery after DMEK had 20/25 or better vision, compared with 39% of patients undergoing a triple procedure. Additionally, 97% of patients who underwent cataract surgery after DMEK had 20/40 or better vision, compared to 80% of patients who underwent a triple procedure, she said.

“Staging cataract surgery after DMEK can preserve accommodation longer in your young patients. It provides better uncorrected distance vision, more precise targeting of the spherical equivalent refraction, more accurate reduction of refractive cylinder with toric lenses, and with appropriate techniques no significant increase in endothelial cell loss,” Price said.

Price noted in her practice DMEK alone is offered to patients under 50 years of age with a clear lens and a deep anterior chamber. It is also offered to older patients with a deep anterior chamber who want a multifocal IOL or excellent UDVA.

“Of course, we clearly explain to them if they have DMEK alone they will need cataract surgery at a later timepoint,” she said.

– by Robert Linnehan

Reference: Price MO. Hitting the refractive target with combined vs. sequential DMEK and cataract surgery. Presented at: American Academy of Ophthalmology meeting; Oct. 27-30, 2018; Chicago.

Disclosure: Price reports no relevant financial disclosures.