Refractive outcome and tomographic changes after Descemet membrane endothelial keratoplasty in pseudophakic eyes with Fuchs’ endothelial dystrophy

Abstract

Purpose To analyze refractive and topographic changes secondary to Descemet membrane endothelial keratoplasty (DMEK) in pseudophakic eyes with Fuchs’ endothelial dystrophy (FED). Methods Eighty-seven pseudophakic eyes of 74 patients who underwent subsequent DMEK surgery for corneal endothelial decompensation and associated visual impairment were included. Median post-operative follow-up time was 12 months (range: 3–26 months). Main outcome measures were pre- and post-operative manifest refraction, anterior and posterior corneal astigmatism, simulated keratometry (CASimK) and Q value obtained by Scheimpflug imaging. Secondary outcome measures included corrected distance visual acuity (CDVA), central corneal densitometry, central corneal thickness, corneal volume (CV), anterior chamber volume (ACV) and anterior chamber depth (ACD). Results After DMEK surgery, mean pre-operative spherical equivalent (± SD) changed from + 0.04 ± 1.73 D to + 0.37 ± 1.30 D post-operatively (p = 0.06). CDVA, proportion of emmetropic eyes, ACV and ACD increased significantly during follow-up. There was also a significant decrease in posterior corneal astigmatism, central corneal densitometry, central corneal thickness and corneal volume over time (p = 0.001). Only anterior corneal astigmatism and simulated keratometry (CASimK) remained fairly stable after DMEK. Conclusion Despite tendencies toward a hyperopic shift, changes in SE were not significant and refraction remained overall stable in pseudophakic patients undergoing DMEK for FED. Analysis of corneal parameters by Scheimpflug imaging mainly revealed changes in posterior corneal astigmatism pointing out the relevance of posterior corneal profile changes during edema resolution after DMEK.

Refractive outcomes after DMEK: meta-analysis

“…The pooled estimate for the mean refractive outcomes of all 29 studies after DMEK was +0.43 diopters (D) (95% CI, 0.31-0.55) (Figure 2). 11,20–47 We observed substantial variation between the reported results, with about I 2 = 82% of the overall variability being attributed to heterogeneity between studies. Twenty-seven studies found a hyperopic shift after DMEK (Figure 3).…”

“…27 Although no information on subjective refraction, astigmatism, or anterior topography was available in 31% (9 of 29) of studies, 41% (12 of 29) of studies observed no differences in preoperative and postoperative refractive cylinder or astigmatism. 21,22,24,25,27,33,35,36,38,42 In 8 (27.6%) studies with tomographic analysis, however, there was a statistically significant steepening of posterior corneal topography. 20,21,23,24,39,41,42,46 In a study of 87 pseudophakic eyes undergoing DMEK, Agha et al reported that postoperative changes were mainly observed in the posterior corneal surface, with a statistically significant reduction of posterior corneal astigmatism from 0.59 ± 0.56 D to 0.39 ± 0.27 D. 24 Moreover, the authors observed an increase in the number of eyes exhibiting an against-the-rule astigmatism from 42.8% to 73.6%, although the proportion of eyes with with-the-rule and oblique astigmatism decreased after DMEK.…”

“…11,[20][21][22][23][24][25][26][28][29][30][31][32][33][35][36][37][38][39][40][41][42][43][44][45][46][47] The hyperopic shift ranged between 0 and +0.5 D in 19 studies and between +0.5 D and +1.0 D in 6 studies (Figure 3). [20][21][22][23][24][25][26][28][29][30][31][32][33][35][36][37][38][41][42][43][44][45][46][47] Two groups reported a refracti...…”

“…20,21,23,24,39,41,42,46 In a study of 87 pseudophakic eyes undergoing DMEK, Agha et al reported that postoperative changes were mainly observed in the posterior corneal surface, with a statistically significant reduction of posterior corneal astigmatism from 0.59 ± 0.56 D to 0.39 ± 0.27 D. 24 Moreover, the authors observed an increase in the number of eyes exhibiting an against-the-rule astigmatism from 42.8% to 73.6%, although the proportion of eyes with with-the-rule and oblique astigmatism decreased after DMEK. 24 By contrast, the postoperative change in the anterior corneal curvature was inconsistent throughout the literature, with only 2 studies (6.9%) reporting a significant difference, whereas 5 studies (17.2%) did not.…”

Descemet Membrane Endothelial Keratoplasty–Induced Refractive Shift and Descemet Membrane Endothelial Keratoplasty–Induced Intraocular Lens Calculation Error

“…10–13 The hyperopic shift after DMEK is a frequently described phenomenon, observed in standalone DMEK procedure and in the DMEK triple procedure. 11–24…”