Outcome of phacoemulsification after Descemet membrane endothelial keratoplasty (DMEK)

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


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.


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.


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.

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