Manual Medium Incision Cataract Surgery with Descemet’s Stripping Endothelial Keratoplasty: A Novel Triple Procedure

Abstract

Purpose . To describe the surgical technique and outcomes of combined Descemet’s stripping endothelial keratoplasty and medium incision manual cataract surgery (MICS) in Chinese eyes. Methods . Surgery was performed in 8 eyes of 7 patients (5 females, 2 males). Primary outcomes included success of the surgery and final outcomes. Results . Surgery was performed in patients with Fuchs’ endothelial dystrophy and cataract (mean age 75.5 ± 3.64 years). MICS tunnel was used to insert the donor lenticule into the anterior chamber. All surgeries were performed successfully. Graft dislocation was seen in 1 eye requiring repositioning with intracameral sulfur hexafluoride gas on the first postoperative day. Graft rejection was noted in one patient at the end of one year. The mean decimal best-corrected visual acuity improved from 0.1 ± 0.07 to 0.3 ± 0.15 . Suboptimal visual acuity in 2 cases was due to radiotherapy-related optic neuropathy ( n = 1 ) and myopic maculopathy ( n = 1 ) . The mean target spherical refraction was - 1.11 ± 0.17 diopters (myopic) and the mean achieved spherical refraction was 1.18 ± 0.87 diopters (hyperopic) resulting in a mean hyperopic shift of 2.2 diopters. Conclusions . The approach of combined Descemet’s stripping endothelial keratoplasty and MICS is a viable surgical technique for cases with endothelial dysfunction and cataract.