title: Descemet's membrane endothelial keratoplasty: clinical results of single versus triple procedures (combined with cataract surgery).
abstract: OBJECTIVE
  To compare the outcomes of triple Descemet's membrane endothelial keratoplasty (DMEK) versus DMEK alone in pseudophakic eyes.
  
  
  METHODS
  Retrospective, comparative, interventional case series.
  
  
  METHODS
  Patients with Fuchs' endothelial dystrophy, secondary corneal edema, and prior failed endothelial keratoplasty with or without prior cataract extraction.
  
  
  METHODS
  Outcomes of 492 DMEK procedures performed between April 2010 and August 2012 were reviewed; 292 pseudophakic eyes underwent DMEK (group 1) and 200 eyes had concurrent cataract surgery with DMEK (group 2).
  
  
  METHODS
  Corrected distance visual acuity, endothelial cell loss, immediate and early postoperative complications.
  
  
  RESULTS
  The mean age at the time of surgery was 70 years (range, 47-94 years) in group 1 and 64 years (range, 46-90 years) in group 2 (P <0.0001). At 6 months, the median corrected distance visual acuity was 20/25 (range, 20/16-20/80; n = 164) in group 1 and 20/20 (range, 20/16-20/100; n = 121) in group 2 (P <0.0001), excluding 21 eyes with retinal or optic nerve problems. The DMEK graft failed to clear in 9 eyes (3.1%) in group 1 and 7 eyes (3.5%) in group 2 (P = 0.34); all were regrafted successfully with DMEK. No further graft failures occurred during the follow-up period. The air reinjection rate was 30% in group 1 and 29% in group 2 (P = 0.69). The air reinjection rate dropped significantly in both groups, from 45% to 16%, after use of viscoelastic was eliminated during the tissue insertion step. The median endothelial cell loss at 3 to 6 months did not differ significantly between groups (26% in both).
  
  
  CONCLUSIONS
  Triple DMEK was not associated with any higher risk of complications than DMEK alone. Compared with sequential management of patients with concomitant cataract and endothelial dysfunction, triple DMEK is an effective strategy in rapid visual rehabilitation and offers the advantage of a 1-stage procedure, with reduced risks and costs.
authors.affiliation: Price Vision Group, Indianapolis, Indiana; Cornea Research Foundation of America, Indianapolis, Indiana.
authors.forename: Sunita
authors.initials: S
authors.lastname: Chaurasia
authors.affiliation: Price Vision Group, Indianapolis, Indiana.
authors.forename: Francis W
authors.initials: FW
authors.lastname: Price
authors.affiliation: Cornea Research Foundation of America, Indianapolis, Indiana.
authors.forename: Lauren
authors.initials: L
authors.lastname: Gunderson
authors.affiliation: Cornea Research Foundation of America, Indianapolis, Indiana. Electronic address: mprice@cornea.org.
authors.forename: Marianne O
authors.initials: MO
authors.lastname: Price
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002386:Cataract / Q000150:complications; D002452:Cell Count; D015715:Corneal Edema / Q000601:surgery*; D055954:Corneal Endothelial Cell Loss / Q000175:diagnosis; D057111:Descemet Stripping Endothelial Keratoplasty; D004728:Endothelium, Corneal / Q000473:pathology; D005260:Female; D005642:Fuchs' Endothelial Dystrophy / Q000601:surgery*; D006084:Graft Rejection; D006801:Humans; D019654:Lens Implantation, Intraocular; D008297:Male; D008875:Middle Aged; D018918:Phacoemulsification; D011183:Postoperative Complications; D019591:Pseudophakia / Q000601:surgery*; D012086:Reoperation; D012189:Retrospective Studies; D016896:Treatment Outcome; D014786:Vision Disorders / Q000534:rehabilitation; D014792:Visual Acuity / Q000502:physiology