Journal of cataract and refractive surgery · 2011
Refractive change and stability after Descemet membrane endothelial keratoplasty. Effect of corneal dehydration-induced hyperopic shift on intraocular lens power calculation.
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Ham Lisanne, Dapena Isabel, Moutsouris Kyros, Balachandran Chandra, Frank Laurence E, van Dijk Korine, Melles Gerrit R J
Аннотация
PURPOSE: To determine the refractive change and stability of the transplanted cornea after Descemet membrane endothelial keratoplasty (DMEK) through a 3.0 mm clear corneal incision.
SETTING: Tertiary referral center.
DESIGN: Cohort study.
METHODS: Subjective and objective refractive data from pseudophakic eyes were obtained before and 3 and 6 months after DMEK.
RESULTS: The study comprised 50 eyes, 7 were phakic and 43 pseudophakic. Six months postoperatively, the corrected distance visual acuity was 20/25 (0.8) or better in 38 eyes (74%). The mean increase in spherical equivalent at 6 months (N = 50) was +0.32 diopter (D) ± 1.01 D (SD) (P=.0304) and in refractive cylinder, -0.48 ± 1.02 D (P=.001). Although Scheimpflug imaging showed a stable anterior corneal curvature, the posterior curvature increased from 5.50 ± 0.5 D preoperatively to 6.40 ± 0.4 D at 6 months and pachymetry decreased from 672 ± 82 μm to 540 ± 59 μm, respectively (both N = 32) (both P=.000).
CONCLUSIONS: After DMEK, a slight preoperative to postoperative refractive change and stabilization at 3 months occurred that may induce a hyperopic shift that was not the result of the negative lenticule effect of DSEK/DSAEK. Thus, in DMEK, the hyperopic shift may result from a reversal of a preceding myopic shift induced by stromal swelling in endothelial disease. If so, normal intraocular power nomograms apply for cataract surgery before or during DMEK.
SETTING: Tertiary referral center.
DESIGN: Cohort study.
METHODS: Subjective and objective refractive data from pseudophakic eyes were obtained before and 3 and 6 months after DMEK.
RESULTS: The study comprised 50 eyes, 7 were phakic and 43 pseudophakic. Six months postoperatively, the corrected distance visual acuity was 20/25 (0.8) or better in 38 eyes (74%). The mean increase in spherical equivalent at 6 months (N = 50) was +0.32 diopter (D) ± 1.01 D (SD) (P=.0304) and in refractive cylinder, -0.48 ± 1.02 D (P=.001). Although Scheimpflug imaging showed a stable anterior corneal curvature, the posterior curvature increased from 5.50 ± 0.5 D preoperatively to 6.40 ± 0.4 D at 6 months and pachymetry decreased from 672 ± 82 μm to 540 ± 59 μm, respectively (both N = 32) (both P=.000).
CONCLUSIONS: After DMEK, a slight preoperative to postoperative refractive change and stabilization at 3 months occurred that may induce a hyperopic shift that was not the result of the negative lenticule effect of DSEK/DSAEK. Thus, in DMEK, the hyperopic shift may result from a reversal of a preceding myopic shift induced by stromal swelling in endothelial disease. If so, normal intraocular power nomograms apply for cataract surgery before or during DMEK.
Предметные рубрики MeSH
AdultAgedAged, 80 and overCohort StudiesCorneaCorneal TopographyDescemet Stripping Endothelial KeratoplastyDesiccationFemaleHumansHyperopiaLens Implantation, IntraocularLenses, IntraocularMaleMiddle AgedNomogramsOptics and PhotonicsPhacoemulsificationPostoperative ComplicationsProspective StudiesPseudophakiaRefraction, OcularVisual Acuity