title: DMEK in phakic eyes: targeted therapy or highway to cataract surgery?
abstract: OBJECTIVE
  To investigate outcome and postoperative complications in patients undergoing isolated DMEK in phakic eyes compared to patients undergoing DMEK combined with cataract surgery (triple procedure).
  
  
  METHODS
  A retrospective analysis of 13 eyes undergoing DMEK in phakic eyes and 54 eyes undergoing triple procedure. Intraoperative and postoperative complications were recorded, visual acuity, refraction outcome, central corneal thickness, endothelial cell count and optical coherence tomography (OCT) of the anterior eye segment were evaluated 6 months postoperatively.
  
  
  RESULTS
  Graft detachment occurred in two eyes (18 %) undergoing phakic DMEK surgery and 23 eyes (50 %) undergoing triple procedure. Two eyes of the phakic group needed subsequent cataract surgery. In all cases, visual acuity significantly increased with a medium visual acuity of 0.13 ± 0.12 (phakic group, p = 0.005) and 0.15 ± 0.11 (triple group, p < 0.001) logMAR. Visual acuity of at least 0.1 logMAR was found in 55 % (phakic group) and 52 % (triple procedure group) of eyes. In the group after triple procedure, there were 62.8 % of eyes within 1 D of emmetropia. Corneal thickness was reduced to 515.3 ± 36.9 μm (phakic group, p = 0.012) and 516.5 ± 40.4 μm (triple group, p < 0.001). Endothelial cell count was reduced to 1529.7 ± 695.6/mm(2) (phakic group, p = 0.008) and 1,676.8 ± 355.2/mm(2) (triple group, p < 0.001).
  
  
  CONCLUSIONS
  DMEK in phakic eyes provides very good visual acuity with lower postoperative complications compared to eyes undergoing triple procedure. As the accommodative power can be preserved, this method is especially interesting for young patients.
authors: Klinik für Augenheilkunde, Charité Universitätsmedizin Berlin, Campus Virchow-Klinikum, Mittelallee 4, Augustenburgerplatz 1, 13353, Berlin, Germany, enken.gundlach@charite.de.
authors: Enken
authors: E
authors: Gundlach
authors: Anna-Karina B
authors: AK
authors: Maier
authors: Mikaella-Anthia
authors: MA
authors: Tsangaridou
authors: Aline Isabel
authors: AI
authors: Riechardt
authors: Tobias
authors: T
authors: Brockmann
authors: Eckart
authors: E
authors: Bertelmann
authors: Antonia M
authors: AM
authors: Joussen
authors: Necip
authors: N
authors: Torun
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002452:Cell Count; D055954:Corneal Endothelial Cell Loss / Q000473:pathology; D057111:Descemet Stripping Endothelial Keratoplasty; D004728:Endothelium, Corneal / Q000473:pathology; D005260:Female; D005642:Fuchs' Endothelial Dystrophy / Q000601:surgery*; D006801:Humans; D007431:Intraoperative Complications; D019654:Lens Implantation, Intraocular; D007908:Lens, Crystalline / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D018918:Phacoemulsification; D011183:Postoperative Complications; D012029:Refraction, Ocular / Q000502:physiology; D012189:Retrospective Studies; D016896:Treatment Outcome; D014792:Visual Acuity / Q000502:physiology