Differences in complications between staged and combined DMEK and cataract surgery

Theme: Cornea, external disease & refractive surgery
What: Posters
Part of: Poster Presentations / Présentations d'affiches | Break in the Exhibition Hall / Pause dans la salle d’exposition
When: 6/1/2024, 10:30 AM - 11:15 AM
Where: Exhibition Hall | Salle d'exposition

Abstract

Purpose: Patients with cataract and Fuchs endothelial corneal dystrophy (FECD) undergo cataract surgery and Descemet’s membrane endothelial keratoplasty (DMEK). These surgeries can be combined or staged. The combined approach is more cost-effective, results in greater corneal clarity, and has similar clinical outcomes as staged surgeries. However, the combined approach may have a higher incidence of incomplete graft adherence and graft detachment. This quality improvement study explored the clinical outcomes associated with staged and combined DMEK and cataract surgeries. 

Study design: This is a retrospective case series of 20 eyes (19 pseudophakic, 1 phakic) in 14 patients who underwent the DMEK procedure between May 2017-January 2023 and 24 eyes in 17 patients who underwent a combined DMEK and cataract procedure between January 2018-February 2023.  

Methods: Patients’ visual acuity (VA), intraocular pressure (IOP), and complications were recorded one day, three-five days, one week, two weeks, three months, and six months post-operation. Incidences of high IOP (higher than 21 mmHg), incomplete graft adherence requiring rebubbling, graft failure needing secondary Descemet Stripping Automated Endothelial Keratoplasty (DSAEK), signs of inflammation, allergic response, temporal edema, glares, and floaters were recorded. VA was converted to logarithm of the minimum angle of resolution (logMAR). VA, IOP, and complications were compared between one week, two weeks, three months, and six months post-operation. Statistical significance was calculated using Fisher’s exact test.

Results: The most prevalent complications were high IOP (7/20 in staged surgeries, 6/24 in combined surgeries) and incomplete adherence requiring rebubbling (8/20 in staged surgeries, 4/24 in combined surgeries). There was no statistically significant difference between any single complication (p>0.05) or for overall number of complications (p=0.81). There was no statistically significant difference in VA at one week (p=0.36), two weeks (p=0.19), three months (p=0.17), or six months (p=0.43) post-operation. The combined DMEK and cataract surgery had lower IOP one week post-operation (p=0.02). However, there was no statistically significant difference in IOP at two weeks (p=0.32), three months (p=0.59), or six months (p=0.42) post-operation. 

Conclusions: Combined and staged DMEK and cataract procedures demonstrated similar clinical outcomes in VA, IOP, and complications post-operation. Combined DMEK and cataract surgeries resulted in a lower IOP one week post-operation but was not significantly different beyond the first week. The two methods were comparable in visual outcomes in this study with limited sample size. Future research should employ randomized controlled trials with a broader sample of eyes to discern whether combined DMEK and cataract surgery is comparable or superior to staged DMEK and cataract surgery.

Presenter(s)

Presenting Author: Lucy Yang

Additional Author(s):

Lucy Yang, University of Calgary

Alison Maddigan, Vector Eye Centre

Jamie Bhamra, Vector Eye Centre

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