Phakic DMEK by Jesse Vislisel, MD and Mark A. Greiner, MD

Descemet membrane endothelial keratoplasty (DMEK) is usually performed in pseudophakic patients. However, we consider performing DMEK in the presence of a natural crystalline lens in patients under 50 with minimal cataract. In this case, we elected to perform phakic DMEK in an older patient with mild cataract due to his very long axial eye length and concern for difficulty shallowing the chamber without the volume of the natural crystalline lens. When performing phakic DMEK cases, we create a laser peripheral iridotomy prior to the operation to minimize risk of cataract formation and capsular damage.