Combined Descemet membrane endothelial keratoplasty and extracapsular cataract extraction: management of an intraoperative challenge

Abstract

Endothelial corneal transplantation (Descemet membrane endothelial keratoplasty [DMEK]) combined with cataract surgery as a triple procedure has been demonstrated to be safe and cost-effective. Where the corneal opacity is more significant, this may preclude safe phacoemulsification. This may not be apparent during preoperative assessment. An 80-year-old man with corneal decompensation secondary to herpes simplex endotheliitis and cataract underwent combined cataract extraction and DMEK. Intraoperatively, the surgical view became too poor to continue with conventional phacoemulsification. The lens was extracted by conversion to extracapsular surgery (extracapsular cataract extraction [ECCE]). Descemet membrane endothelial keratoplasty surgery was then completed without complication. Postoperatively, the graft remained attached, and by 3 months, acuity improved to 20/32 (Snellen). A poor intraoperative view during the triple procedure does not preclude a successful outcome. Corneal opacity can be overcome, avoiding full-thickness penetrating keratoplasty or discarding healthy graft tissue. Conversion to ECCE combined with DMEK is a feasible option intraoperatively that can still provide good outcomes.