Femtosecond Laser–Assisted Cataract Surgery Combined With Descemet Membrane Endothelial Keratoplasty

Sunday, April 19, 2015: 4:06 PM
Room 5A (San Diego Convention Center)
Nicolas C. Pereira, MD
Adriana S. Forseto, MD
Ruy N. Cunha Filho, MD
Walton Nosť, MD, PhD

Purpose
To describe the results of femtosecond laser assisted phacoemulsification (FLACS) combined with Descemet Membrane Endothelial Keratoplasty (DMEK).

Methods
Retrospective review of eight patients with Fuchs Distrophy and cataract  that underwent FLACS combined with DMEK. All the surgeries were performed under topical anesthesia. Prior to surgery, a deturgescent agent (glycerol  drops) was instilled on the cornea. The primary and secondary incisions, capsulorhexis and lens fragmentation were performed with LensX femtosecond laser platform. The laser energy settings were higher than conventional cataract surgery with femtosecond laser due to the presence of corneal edema. The Infinity phacoemulsification system was used for nucleus aspiration. After intraocular lens insertion and viscoelastic aspiration, the stripping of the Descemet Membrane was performed and the donor tissue inserted. Clinical results were described.

Results
Incision related complications were observed in two eyes: in one case the secondary incision was not completed due to vacuum loss  at the end of the procedure, and in the other one it could not be opened due to its location posterior to the limbus. Capsulorhexis’ tags occurred in another patient but it was manually completed with no further complications. In this eye, the lens fragmentation was not completed at the same quadrant of the capsulorhexis’ tags. No postoperative complications were noted. At 1 month after surgery, all eyes had best corrected distance visual acuity of 20/30 or better.

Conclusion
Femtosecond laser assisted cataract surgery combined with Descemet Membrane Endothelial Keratoplasty is a safe procedure for eyes with both cataract and endothelial disfunction. The presence of edematous cornea does not prevent the use of the femtosecond laser even though higher energy settings may be necessary.