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Luke Potts, Alex Bauer, Shin-Yi Chen, Michael D. Straiko, Mark A Terry; Refractive outcomes of sequential versus combined cataract surgery and DMEK in eyes with prior LASIK. Invest. Ophthalmol. Vis. Sci. 2019;60(9):5053. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
For patients with a history of laser-assisted in situ keratomileusis (LASIK) presenting with Fuch's dystrophy and cataract it is unknown whether there is an advantage to performing cataract surgery after Descemet membrane endothelial keratoplasty (DMEK) versus combining the two surgeries. The purpose of this study was to determine whether refractive outcome predictability and post-operative visual acuity differ for eyes with prior LASIK that have cataract surgery performed subsequent to DMEK versus combined with DMEK.
This retrospective cohort study involved 6 eyes with a history of LASIK and DMEK which then had cataract surgery, and 5 eyes with a history of LASIK that had cataract surgery combined with DMEK. All patients had DMEK for Fuch’s endothelial dystrophy. Intraocular lens choice was based upon results from the American Society of Cataract and Refractive Surgery post-LASIK online calculator using the Barrett True-K formula. We compared post-operative uncorrected visual acuity (UCVA) and best-corrected visual acuity (BCVA) between both groups. Mean absolute error (MAE) was calculated as the average of absolute values of the difference between the predicted spherical equivalent and the stable post-operative spherical equivalent of the manifest refraction at 2-12 months. Two-tailed Student’s t test assuming equal variances was used to determine significance for P < 0.05.
No differences were found between post-operative average UCVA of 0.21 logMAR (Snellen 20/32) for sequential surgery versus 0.22 logMAR (Snellen 20/33) for combined surgery, or between post-operative BCVA of 0.066 logMAR (Snellen 20/23) for sequential surgery versus 0.055 logMAR (Snellen 20/22) for combined surgery. MAE for the sequential surgery group was 0.35D (range: 0.025 to 0.75D), while for the combined group was 0.78D (range: 0.25 to 1.7D), a statistically significant difference.
For patients with prior LASIK that have Fuch’s dystrophy and cataract, surgeons may stage cataract surgery and DMEK to improve the quality of biometric measurements for cataract surgery. The results of this small cohort study suggest that visual acuity outcomes are similar using either a staged or a combined surgical approach. However, using a widely available online post-LASIK calculator, refractive prediction error was less when cataract surgery was performed after DMEK compared with combined surgery.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.
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