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Phakic DMEK

In general I feel that phakic DMEK is an easier procedure than DMEK after or combined with cataract surgery. This observation helps me determine when to perform DMEK with an intact lens. Here are my general guidelines: 1. Phakic DMEK is reasonable when cataract is minimal. There is no reason to remove an intact lens. For example, the patient in this video is in her forties and has a clear lens. 2. When a patient desires a toric intraocular lens. DMEK can sometimes unpredictably change corneal curvature after healing. If a patient is motivated to obtain astigmatism correction with their cataract surgery, then I recommend performing DMEK first and proceeding with cataract surgery at least one month, but preferably three months after the transplant. 3. Pseudophakic DMEK can be challenging in large eyes with deep anterior chambers as the graft can be difficult to unfold. If I have a patient with very high myopia and a large anterior chamber, I may consider doing their surgery with their lens intact even if they have a significant cataract.