Clinical outcomes after DClinical outcomes after Descemets escemets MMembrane Endothelial Keratoplasty embrane Endothelial Keratoplasty with Stromal Rim with Stromal Rim surgery combined surgery combined

with cataract extractionwith cataract extraction

Magdaléna Netuková, Deli Siveková, Katerina Liehneová Magdaléna Netuková, Deli Siveková, Katerina Liehneová Magdalena Vokrojová, Pavel StudenýMagdalena Vokrojová, Pavel Studený

Dpt. of Ophthalmology, Vinohrady Teaching HospitalDpt. of Ophthalmology, Vinohrady Teaching HospitalSrobarova 50, 100 34 Prague 10, Czech RepublicSrobarova 50, 100 34 Prague 10, Czech Republic

Authors have NO finatial interestAuthors have NO finatial interest

Aim of the studyAim of the study To present clinical outcomes To present clinical outcomes ofof patients who patients who

underwent Dunderwent Descemets escemets MMembrane embrane EEndothelial ndothelial KKeratoplasty with Stromal Rim (DMEKeratoplasty with Stromal Rim (DMEK-S-S)) combined with cataract extraction in a single combined with cataract extraction in a single surgerysurgery

To evaluate safety and efficacy of this tripple To evaluate safety and efficacy of this tripple procedureprocedure

Patients and Methods Patients and Methods

RRetrospective nonrandomized single center etrospective nonrandomized single center studystudy

30 eyes of 25 patients were enrolled30 eyes of 25 patients were enrolled 14 female, 11 male 14 female, 11 male Indication for this surgery was cataract with Indication for this surgery was cataract with

endothelial dystrophyendothelial dystrophy Mean age was 68 years (55-78 years)Mean age was 68 years (55-78 years) Mean follow-up time was 15 months (9-26 Mean follow-up time was 15 months (9-26

months)months)

Fuchs endothelial dystrophy

Methods - pocedure Methods - pocedure Standard Cataract surgery with single-piece Standard Cataract surgery with single-piece

Hyrophobic Acrylic IOL implantationHyrophobic Acrylic IOL implantation Profound removal of all viscoelastic material Profound removal of all viscoelastic material Descemetorhexis with help of Trypan Blue Descemetorhexis with help of Trypan Blue

stainingstaining Preparation of donor Descemets Membrane Preparation of donor Descemets Membrane

with stromal rim with stromal rim (details – Studeny P., et al., Br. J. Ophthalmol., 2009)(details – Studeny P., et al., Br. J. Ophthalmol., 2009)

Implantation of the MembraneImplantation of the Membrane Fixation of the Membrane with Air bubbleFixation of the Membrane with Air bubble

ResultsResults

UCVAUCVA BCVABCVA SESE

PreopPreop 0,260,26 (±0,14 SD)(±0,14 SD) 0,350,35 (±0,14 SD)(±0,14 SD) -0,07 D-0,07 D (±1,21 SD)(±1,21 SD)

PostopPostop 0,640,64 (±0,24 SD)(±0,24 SD) 0,810,81 (±0,21 SD)(±0,21 SD) +0,21 D+0,21 D (±0,6 SD)(±0,6 SD)

Endothelial Cell Dednsity postop:Endothelial Cell Dednsity postop:

983 bb/mm983 bb/mm22 (±270,03 SD)(±270,03 SD)

ComplicationsComplications

Peroperative:Peroperative: No major peroperative complications were No major peroperative complications were

detecteddetected

Postoperative:Postoperative: In 6 eyes air had to be reinjected, In 6 eyes air had to be reinjected, usually usually

because of partial because of partial graft graft detachmentsdetachments 3 grafts failed to clear and required an exchange3 grafts failed to clear and required an exchange

ConclusionConclusion

Our experience shows, that the combination Our experience shows, that the combination of of DMEK-S and cataract surgery DMEK-S and cataract surgery is safe is safe and effectiveand effective procedure procedure for the patient for the patient

Strictly individual aproach to each patient is Strictly individual aproach to each patient is necessarynecessary

Good patient´s compliance is importantGood patient´s compliance is important

Thank youThank you

Magdalena Netukova, MD PhDMagdalena Netukova, MD PhDDpt. of OphthalmologyDpt. of OphthalmologyVinohrady Teaching HospitalVinohrady Teaching HospitalSrobarova 50, 100 34 Prague 10Srobarova 50, 100 34 Prague 10Czech RepublicCzech RepublicE-mail: netukova@fnkv.czE-mail: netukova@fnkv.cz