Performing DMEK with Other Surgical Procedures: Staged vs. Combined Approaches in Straightforward Cases

Purpose of review: Various strategies exist in the approach to patients requiring both cataract removal and endothelial keratoplasty. In this review, we seek to define the differences in keratoplasty technique relevant to a multi-procedure case; to discuss known outcomes of the triple procedure, as well as outcome differences compared to staged procedures; and to identify knowledge gaps in need of further investigation. Recent findings: Optimal management of ocular comorbidities is becoming increasingly relevant with the rapid growth of Descemet membrane endothelial keratoplasty (DMEK) worldwide. The triple procedure combines endothelial keratoplasty, cataract extraction with lens implantation, and surgical iridotomy into a single surgical event. However, many approaches exist with regard to staged vs. combined procedures, and there are distinct advantages to each approach. Summary: A surgeon’s experience and technical comfort will ultimately guide surgical planning. Deciding when to perform these procedures in a way most beneficial to the patient is essential to preoperative planning.