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

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.