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Victor A Augustin, Julia Weller, Friedrich E Kruse, Theofilos Tourtas; Can we optimize the refractive target in triple Descemet membrane endothelial keratoplasty in the fellow eye after surgery in the first eye?. Invest. Ophthalmol. Vis. Sci. 2018;59(9):1326. doi: https://doi.org/.
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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. The aim of this study was to evaluate if the refractive target in the second eye can be optimized based on the refractive outcome of the first eye after triple-DMEK.
In this retrospective, single-center, consecutive case series the refractive outcomes of 254 of 127 patients undergoing triple-DMEK in both eyes for Fuchs endothelial corneal dystrophy were analyzed. Mean follow-up time was 6.3 ± 3.8 months. Eyes with coexisting comorbidities were excluded. Main outcome measures were spherical equivalent (SE) outcome (shift-calculations), best-corrected visual acuity (BCVA), central corneal thickness (CCT), posterior simulated keratometry (PentacamTM, Oculus, Wetzlar, Germany). The study was approved by the Institutional Review Board at Friedrich Alexander University of Erlangen as a retrospective data review.
Mean BCVA before surgery was 0.51 ± 0.24 (logMAR) and increased to 0.19 ± 0.15 (logMAR) 3 months after surgery (p<0.001). Mean postoperative BCVA of the first eye was 0.20 ± 0.15 and of the second eye 0.18 ± 0.15 (p=0.490).Three months after surgery a mean hyperopic shift of 0.98 ± 0.89 D was observed. The refractive shift was 1.03 ± 0.93 D in the first eye and 0.92 ± 1.02 D in the second eye (p=0.435). However, the mean difference of the postoperative refractive shift in a paired analysis between the first and second eye was 0.49 ± 0.43 D.Three months after surgery we noticed a reduction in CCT of 104.27 ± 98.69 μm in the first eye and 90.52 ± 48.78 μm in the second eye (p=0.300). Similarly, 3 months after surgery the posterior corneal curvature steepened by 0.57 ± 0.35 D in the first eye and 0.58 ± 0.46 D in second eye (p=0.730).
In our fellow eye comparison the refractive shift after triple-DMEK in the first eye was comparable to the shift in the second eye. As a consequence, the refractive outcome after surgery in the first eye may serve as a reference for optimizing the refractive target in the second eye. Further studies investigating the influence of corneal parameters on refractive shift are needed for a more predictable lens power selection.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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