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T. E. Marra, L. Y. Ho, D. K. Dhaliwal, F. S. Mah, R. J. Noecker; DSAEK Combined With Phacoemulsification: Compensating for the Hyperopic Shift. Invest. Ophthalmol. Vis. Sci. 2008;49(13):2341.
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© ARVO (1962-2015); The Authors (2016-present)
To provide a summary of all combined DSAEK, phacoemulsification, and intraocular lens insertion cases (triple procedures) performed at UPMC Eye Center and present theories regarding the hyperopic shift with DSAEK and how to compensate for this shift.
In this retrospective chart review, 12 patients (13 eyes) had DSAEK combined with CE and IOL insertion at the UPMC Eye Center by two surgeons (DKD, FSM). Five patients were excluded from this retrospective consecutive case series due to proximity of surgery and confounding eye disease. Pre/post-operative LogMAR visual acuity and manifest spherical equivalents were assessed and the outcomes are presented. The mean difference between the targeted refraction and actual postoperative manifest spherical equivalent refraction was also calculated. Statistical analysis with paired student T-tests was performed using Microsoft Office Excel 2003 (Seattle, WA).
The mean pre-operative and post-operative LogMAR visual acuity were 0.70 ± 0.68 (range 0.3-2.3) and 0.22 ± 0.18 (range 0.0-0.5) (p=0.05). The mean pre-operative and post-operative manifest spherical equivalent (D) were 0.91 ± 2.82 (range -1.75 to +5.13) and 0.13 ± 1.43 (range -1.25 to +3.13). The mean pre-operative and post-operative refractive astigmatism (D) were 0.94 ± 0.55 and 0.88 ± 0.52 (p=0.67). The calculated postoperative refractive target for this series of patients was between -0.18 to -1.4 D and the average difference between the targeted refraction and actual post-operative manifest spherical refraction was a hyperopic shift of +0.90 D.A high resolution Visante OCT (Carl Zeiss Meditec, Jena, Germany) of one of our patients demonstrated a meniscus-shaped donor lenticle which is thinner in the center and thicker at the edges of the tissue. Using measurements from four different cross sections, the mean thickness of the right lenticle 3.50mm from the visual axis was 144.88 ± 20.45 microns compared to the mean thickness in the center of 71.25 ± 5.50 microns.
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