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Jeffrey G. Eng; Post-operative Refractive Changes after Descemet Stripping Endothelial Keratoplasty. Invest. Ophthalmol. Vis. Sci. 2011;52(14):746.
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To characterize the refractive changes during the post-operative period after Descemet Stripping Endothelial Keratoplasty (DSEK).
9 eyes from 6 patients with Fuchs’ Dystrophy who had DSEK either alone (4 eyes) or in combination with phacoemulsification of cataract with posterior chamber intraocular lens (PCIOL) implantation (5 eyes) were selected for this study. These patients had been followed in the cornea clinic at the University of South Carolina from 2005 to 2010. Charts were reviewed and the post-operative refractions at regular intervals were compared with either the pre-operative refraction in the case of an isolated DSEK or with the target post-operative refraction in the case of DSEK with phacoemulsification/PCIOL implantation.
Patients had been followed post-operatively from a minimum of 6 months to a maximum of 22 months. 6 eyes ultimately developed a hyperopic shift after DSEK, but the other 3 eyes had myopic shifts. Of the 3 eyes with myopic shifts, 2 eyes had isolated DSEK while 1 eye had combination DSEK/phacoemulsification/PCIOL implantation. For the 6 eyes with hyperopic shifts, the average refractive change in spherical equivalents was +1.15 ± 0.20 D at 1 month post-op, +1.33 ± 0.38 D at 3 months post-op, +1.25 ± 0.37 D at 6 months post-op, and +0.67 ± 0.30 D at 1 year post-op. From the 3 eyes with myopic shifts, 2 eyes (1 isolated DSEK and 1 combination DSEK/phacoemulsification/PCIOL implantation) initially demonstrated a hyperopic shift of +1.10 ± 0.10 D that later became a myopic shift with an average refractive change in spherical equivalents of -1.93 ± 1.15 D between 8 months and 15 months post-operatively.
This study suggests that although most eyes initially develop a hyperopic shift after DSEK, the magnitude of this hyperopic shift decreases during the post-operative course and some patients may ultimately develop an overall myopic shift.
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