Descemet membrane endothelial keratoplasty (DMEK) and/or phacoemulsification in phakic eyes with corneal endothelial dystrophy

Background: For phakic patients with Fuchs endothelial dystrophy (FED) undergoing Descemet membrane endothelial keratoplasty (DMEK) there are no clear guidelines whether the crystalline lens should or should not be removed before, during or after DMEK. Material and Methods: Report of clinical experience based on our consecutive series of more than 500 DMEK surgeries. Results: Patients with a significant cataract may profit from cataract surgery primary to DMEK, and if still required, DMEK can be performed as a secondary procedure. For patients with an incipient cataract, the primary cause of the reduced visual acuity or visual complaints (cornea or lens) may first be identified to judge which procedure will contribute to the highest visual improvement. On the other hand, especially young phakic patients with a “clear lens” and significant FED may profit from DMEK first leaving the crystalline lens in situ, while the risk to develop a significant cataract after DMEK is relatively small. Conclusions: Depending on the degree of lens opacification in eyes with endothelial dystrophy, an individual decision may be taken whether or not and in which order cataract surgery and/or DMEK are indicated.