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Christoph Holtmann, Kristina Spaniol, Inga Neumann, Jan Schwinde, Sophia Deffaa, David Finis, Gerd Geerling; Refractive Outcome after Descemet membrane endothelial keratoplasty combined with phacoemulsification and intraocular lens implantation. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):1578.
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© ARVO (1962-2015); The Authors (2016-present)
Descemet Membrane Endothelial Keratoplasty (DMEK) is rapidly gaining acceptance for corneal endothelial disease as the treatment of choice. Since this disease is more prevalent in elderly patients also suffering from cataract, a simultaneous phacoemulsification and intraocular lens implantation is often performed as a triple procedure. Here we evaluate the refractive outcome of 40 cases undergoing DMEK combined with phacoemulsification and intraocular lens implantation (Triple-DMEK).
The clinical records of 39 patients (40 eyes) undergoing Triple-DMEK performed between January 2012 and October 2014 were analyzed retrospectively. Pre- and postoperative (at six weeks) parameters included spherical equivalent (SE, measured by IOL-Master), type and power of intraocular lens, objective and subjective refraction, best-corrected visual acuity (BCVA in [logMAR] units), central corneal thickness (CCT, analyzed by Scheimpflug imaging) and endothelial cell count (ECC). Statistical analysis was performed with SPSS 21.0 and p≤0.05 was considered statistically significant.
Preoperative calculated SE was -0.5 ± 0.5 and postoperative SE 6 weeks after surgery was -0.1 ± 1.6 (p≤0,05). Optical power of the implanted intraocular lens was 20 ± 5 dpt (ranging from 10.5 to 27.5 dpt). BCVA increased from 0.6 ± 0.3 logMAR preoperatively to 0.2 ± 0.2 logMAR after surgery (p≤0,05). ECC decreased from 2499 ±472 /mm² preoperatively to 1683 ±303 /mm² postoperatively (p≤0,001). CCT decreased from 597 ± 104 µm preoperatively to 528 ± 61 µm at 6 weeks after surgery (p≤0,05). Statistical analysis showed no correlation between postop SE deviation and postop reduction in CCT, axial length or a specific type of intraocular lens. A Spearman-Rank analysis showed a correlation between a low postop CCT and a low postop SE deviation (p=0.05, r=0.3).
Postoperative refraction after Triple-DMEK deviates from preoperative aim with a tendency towards a hyperopic shift. In this present cohort this shift tends to be approximately 0.5 dpt and therefore less clinically meaningful at least for simple monofocal lenses. Further prospective studies are needed to improve the outcome especially for multifocal and toric lenses.
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