الفهرس 
Corneal endothelial cell dysfunctionOnly 14 pages are availabe for public view
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Abstract
Patients with corneal endothelial dysfunction have different ages and
may differ in their lens status which may be pseudophakic, aphakic or
phakic (with cataractous lens or clear lens), each case has its plan of
management according to all the data, circumstances and surgeon or patient
preference.
Coexisting cataract usually needs a combined surgical approach
consisting of cataract surgery and simultaneous keratoplasty, called triple
procedure. There are several challenges when performing triple phaco-
DMEK as compared with staged surgery, which may make some surgeons
prefere sequential surgery.
First, scoring of the recipient endothelium in DMEK in
pseudophakic eyes is usually done under air without the use of viscoelastic
which is used in triple procedure. The use of viscoelastic could lead to graft
detachment or graft-host interface haze.
Second, Anterior chamber depth fluctuation is more pronounced in
combined procedure which may make graft unfolding and centration
difficult or lead to more damage to the endothelial cells due to instability of
the inserted IOL. For these reasons, some surgeons may prefer to perform
cataract surgery before DMEK.
Our study confirmed that DMEK results in excellent visual outcomes
either performed in pseudophakic eye or combined with
phacoemulsification, also there is no significant difference in failure rate or
complications.
Triple-DMEK associated with slightly less hyperopic effect than
DMEK in pseudophakic eyes, although it also tended to induce more
Summary and Conclusion
103
rebubbling in first 2 hours post-operative that didn’t affect the long term
visual outcome.
The better spherical equivalence after triple-DMEK reflects the fact
that by conducting phacoemulsification at the same time as DMEK, we can
preventively correct the slight hyperopia that is observed after DMEK
(whereas we cannot do that in pseudophakic DMEK). Our findings suggest
compensating for it by choosing the correct implant as much as possible,
yield final emmetropia or slight myopia.