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A. J. Aldave; Performing Accurate IOL Power Calculations in Patients Undergoing Combined DSEK and Cataract Extraction. Invest. Ophthalmol. Vis. Sci. 2009;50(13):638.
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© ARVO (1962-2015); The Authors (2016-present)
To quantitate the expected refractive shift following DSEK surgery to facilitate selection of the appropriate intraocular lens (IOL) power in patients undergoing combined DSEK and cataract extraction.
The charts of all patients who underwent combined cataract extraction, IOL implantation and DSEK between May 2006 and November 2008 by a single surgeon were reviewed. The difference between the stable post-operative refraction and the expected post-operative refractive error based on the pre-operative IOL power calculation was determined for each patient.
Sixteen cases of combined cataract extraction, IOL implantation and DSEK were performed during the study period. In each case, either a one piece or three piece IOL was placed in the capsular bag. A reliable post-operative refraction was obtained in 13 of the 16 cases (81%); two patients had less than 1 month follow-up and 1 patient had significantly limited visual acuity secondary to a submacular choroidal melanoma. A hyperopic refractive shift was observed in 12 of the 13 eyes, with a mean hyperopic shift of +1.30 D, and a range from +0.20 D to +2.96 D (SD = 0.88 D). One patient experienced a myopic refractive shift of -1.98 D, although as the best-corrected visual acuity was 20/70, the validity of the measured refractive error was questioned.
DSEK surgery is associated with a hyperopic shift of approximately +1.30 D. Given this, as well as the relatively large standard deviation of post-operative refractive errors that was observed, surgeons should select an IOL power that is predicted to result in a post-operative refractive error of -1.50 to -2.00 D when performing combined DSEK and cataract extraction.
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