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Victor A Augustin, Julia M Weller, Friedrich E Kruse, Theofilos Tourtas; Prediction of refractive outcomes in Descemet membrane endothelial keratoplasty combined with cataract surgery . Invest. Ophthalmol. Vis. Sci. 2017;58(8):5692.
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© ARVO (1962-2015); The Authors (2016-present)
Descemet membrane endothelial keratoplasty (DMEK) is often combined with phacoemulsification and intraocular lens implantation (triple-DMEK) in phakic patients. For lens calculation it is crucial to know refractive changes to predict refractive shift after triple-DMEK.
In this retrospective, single-center, consecutive case series the refractive outcomes of 152 consecutive triple-DMEKs in 152 patients with Fuchs endothelial corneal dystrophy were analyzed. Patients were examined preoperatively, as well as 3, 6, and 12 months after surgery. Mean follow-up time was 8.4 months. Eyes with coexisting comorbidities were excluded. Main outcome measures were spherical equivalent (SE) outcomes (shift-calculations), best-corrected visual acuity (BCVA), anterior and posterior simulated keratometry (Pentacam, Oculus, Wetzlar, Germany). The study was approved by the Institutional Review Board at Friedrich Alexander University of Erlangen as a retrospective review of data.
Mean BCVA prior to surgery was 0.32 ± 0.14 (decimal). Three months after surgery a mean hyperopic shift of 1.12 ± 1.1D was observed and remained stable until the last follow-up at 12 months postoperatively (1.22 ± 1.1D). A significantly lower hyperopic shift of 0.63 ± 1.14 was measured in patients with better preoperative BCVA (> 0.4 decimal) when compared to worse BCVA (≤ 0.4 decimal) (hyperopic shift 1.24 ± 1.05; p < 0.001). In addition, a significant steepening in mean posterior simulated keratometry (Km: preoperative -5.88 ± 0.46D; 3 months postoperatively -6.61 ± 0.41D; p < 0.001) was observed and remained stable until 12 months follow-up. There were no significant changes in mean anterior simulated keratometry at all points of time.
In our larger series of triple-DMEKs we observed a higher hyperopic shift than previously described. The reason why patients with lower BCVA experienced a higher hyperopic shift is currently unknown. Further studies investigating the influence of morphological corneal parameters on hyperopic shift are needed for accurate lens calculation.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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