Step 3 in the DMEK basics series - here we emphasise the importance of treating the phacoemulsification step in combined DMEK and cataract surgery exactly as you would with standard cataract surgery but avoiding the use of dispersive OVD in the eye (dispersive OVD coats the back of the cornea and may interfere with subsequent graft adhesion). To maximise safety in the phacoemulsification, no not compromise on pupil dilation. If the pupil is well dilated after lens implantation, simply keep the pupil dilated postoperatively to avoid pupil block after the air injection. But if the pupil dilation is poor, use Miochol to constrict the pupil and perform an ocutome peripheral iridotomy. Most cases of combined DMEK and cataract surgery do not need this step.
