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Hans D. Hertzog, Ramya Swamy, MD, MPH, Omar Chaudhary, MD, Neda Shamie, MD; Refractive Change After Combined Descemet’s Membrane Endothelial Keratoplasty, Cataract Extraction, And Intraocular Lens Implantation. Invest. Ophthalmol. Vis. Sci. 2012;53(14):59.
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Descemet’s membrane endothelial keratoplasty (DMEK) alone has been shown to cause minimal refractive change. However, refractive change in combined DMEK, cataract extraction (CE), and posterior capsule intraocular lens implantation (PCIOL) procedures has not been previously examined.
Medical records of patients who had undergone combined DMEK, CE, and PCIOL were reviewed retrospectively. Pre-operative target refraction was compared to post-operative refraction at least 6 weeks after undergoing the procedure.
Three patients underwent combined DMEK, CE, and PCIOL extraction performed by the same surgeon using a temporal scleral tunnel approach. All 3 patients had Fuchs endothelial dystrophy. Pre-operative best corrected visual acuity (BCVA) ranged from 20/30 to 20/150. Post operative BCVA was 20/25 to 20/30. All patients received a 1 piece IOL targeting a spherical equivalent of -1 D. The average post-operative refraction was +0.125 D (SD = 0.98) which demonstrated a hyperopic shift of 1.125 D.
This case series demonstrates that patients who have undergone combined DMEK/ CE/PCIOL procedures can have excellent visual outcomes. This case series demonstrates the refractive change may vary based on the individual patient but a -1 D target for implanted IOLs may be most appropriate. Additional studies are needed in order to develop accurate IOL power nomograms for patients undergoing combined DMEK/ CE/ PCIOL procedures.
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