This patient has a cataract as well as Fuch’s corneal dystrophy. Her pre-operative corneal pachymetry is almost 700 microns centrally and she has corneal edema. She has also had a prior trabeculectomy for glaucoma, which is now controlled without progression.
She needs cataract surgery as well as corneal endothelial transplantation. She is undergoing combined cataract surgery with a Descemet’s membrane endothelial keratoplasty. I am using techniques which I have learned from my former resident, P. James Sanchez MD, who is now a corneal specialist at the Devers Eye Institute in Portland, Oregon, USA.
Pre-operatively, we have decided to obtain a pre-cut and pre-loaded transplant tissue. We have also increased our planned IOL power by at least 0.5 diopters (1.0 diopters is also a good measure) to account for the refractive shift expected from the DMEK transplant. We also perform a smaller capsulorhexis in order to keep the IOL in the capsular bag when we have an air bubble present to hold the DMEK graft in place.
Click below to learn from this video about combined DMEK + phaco: