الفهرس | Only 14 pages are availabe for public view |
Abstract Patients with corneal endothelial dysfunction have different ages and may differ in their lens status which may be pseudophakic, aphakic or phakic (with cataractous lens or clear lens), each case has its plan of management according to all the data, circumstances and surgeon or patient preference. Coexisting cataract usually needs a combined surgical approach consisting of cataract surgery and simultaneous keratoplasty, called triple procedure. There are several challenges when performing triple phaco- DMEK as compared with staged surgery, which may make some surgeons prefere sequential surgery. First, scoring of the recipient endothelium in DMEK in pseudophakic eyes is usually done under air without the use of viscoelastic which is used in triple procedure. The use of viscoelastic could lead to graft detachment or graft-host interface haze. Second, Anterior chamber depth fluctuation is more pronounced in combined procedure which may make graft unfolding and centration difficult or lead to more damage to the endothelial cells due to instability of the inserted IOL. For these reasons, some surgeons may prefer to perform cataract surgery before DMEK. Our study confirmed that DMEK results in excellent visual outcomes either performed in pseudophakic eye or combined with phacoemulsification, also there is no significant difference in failure rate or complications. Triple-DMEK associated with slightly less hyperopic effect than DMEK in pseudophakic eyes, although it also tended to induce more Summary and Conclusion 103 rebubbling in first 2 hours post-operative that didn’t affect the long term visual outcome. The better spherical equivalence after triple-DMEK reflects the fact that by conducting phacoemulsification at the same time as DMEK, we can preventively correct the slight hyperopia that is observed after DMEK (whereas we cannot do that in pseudophakic DMEK). Our findings suggest compensating for it by choosing the correct implant as much as possible, yield final emmetropia or slight myopia. |