gms | German Medical Science

Objective: To evaluate the incidence of secondary cataract after Descemet membrane endothelial keratoplasty (DMEK), and the feasibility and outcome of phacoemulsification cataract surgery after DMEK.

Method: From a series of 106 consecutive phakic eyes that underwent DMEK for Fuchs endothelial dystrophy or bullous keratopathy, five (4.7%) required cataract surgery 9.2 (± 3.8) months (range 4 to 14 months) after the initial DMEK. Outcomes after phacoemulsification were retrospectively assessed by reviewing the change in visual acuity, refractive error, endothelial cell density, pachymetry and the incidence of complications.

Result: All phacoemulsification surgeries were uneventful and no dislocations and/or detachments of the Descemet graft were observed. At 6 to 12 months after phacoemulsification, all eyes reached a BCVA of ≥20/30 (0.6) and were within 0.5D of the intraocular lens power calculations. Endothelial cell density decreased from on average 1535 (± 195) cells/mm² before, to 1158 (± 250) cells/mm². No significant changes in pachymetry values were observed up to 6 to 12 months postoperatively. All corneas remained clear throughout the study period.

Conclusion: Phacoemulsification after DMEK can be performed with minimal risk of graft dislocation and may provide good refractive and visual outcomes with an acceptable decrease in endothelial cell density.