Abstract
Purpose: :
To evaluate refractive error after combined Descemet stripping automated endothelial keratoplasty (DSAEK) with cataract surgery and determine whether the intended target refraction was achieved.
Methods: :
87 eyes with Fuchs’ endothelial dystrophy and cataract underwent combined DSAEK with cataract extraction and IOL implantation with ≥6mo follow-up. Eyes with irregular astigmatism or epithelial scraping were excluded. Prospective best-corrected visual acuity (BCVA) and spherical equivalent (SE) were measured pre- and 6mo post-DSAEK. The difference in actual versus targeted SE was calculated.
Results: :
87 eyes were targeted for emetropia or slight myopia, each using an IOL power -1.25 D to -1.50 D more myopic than the intended refractive outcome to compensate for a hyperopic shift anticipated with DSAEK surgery. 6mo after DSAEK, mean BCVA was 20/26 (range 20/20-20/70), and the mean difference between actual versus targeted SE was -0.44 D (range -3.125 D to +1.625 D, SD 0.88 D, 95% CI -0.63 to -0.26).
Conclusions: :
The mean refractive outcome after combined DSAEK with cataract surgery is slightly myopic in this largest study to date of the refractive target after DSAEK. This study demonstrates that the goal of avoiding a postoperative hyperopic refraction is achieved on average, and opens the question of whether the use of an IOL implant -1.00 D to -1.25 D may be considered to achieve a refraction outcome closer to emetropia.
Clinical Trial: :
Devers Eye Institute, Legacy Health System, Patient Registry: DLEK/DSEK Database
Keywords: cornea: endothelium • transplantation