Refractive outcomes of Descemet membrane endothelial keratoplasty triple procedures (combined with cataract surgery)

Schoenberg, Evan D.; Price, Francis W.; Miller, Jalee M.; McKee, Yuri; Price, Marianne O.

doi:10.1016/j.jcrs.2014.09.042

Cited by 91 publications

(94 citation statements)

References 23 publications

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“…Owing to the excellent visual outcome and refractive stability achieved after DMEK [5, 12], (toric) IOL power calculations in patients after phakic DMEK or within the setting of the new triple procedure are becoming a topic of much interest in clinical practice [18, 19]. As previously described, the change in corneal refractive power after DMEK is based mainly on changes in the posterior corneal curvature, whereas the anterior corneal curvature does not alter significantly [5, 11].…”

Section: Discussionmentioning

confidence: 99%

Changes in Anterior, Posterior, and Total Corneal Astigmatism after Descemet Membrane Endothelial Keratoplasty

Alnawaiseh

Zumhagen

Rosentreter

et al. 2017

Journal of Ophthalmology

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Purpose. To evaluate changes in anterior, posterior, and total corneal astigmatism in patients after Descemet membrane endothelial keratoplasty (DMEK). Methods. We retrospectively included 29 eyes of 23 patients (age 67.6 ± 9.8 years, 13 female, 10 male) after DMEK surgery. The magnitude and axis orientation of anterior, posterior, and total corneal astigmatism before and after DMEK were determined using a rotating Scheimpflug system (Pentacam HR, Oculus). Results. The magnitude of anterior, posterior, and total corneal astigmatism in the central cornea did not change significantly after surgery. Before surgery, we found a significant correlation between the magnitudes of anterior and posterior corneal astigmatism (Spearman's correlation coefficient (rS) = 0.526, P = 0.003), while after surgery this correlation was no longer significant (rS = 0.038, P = 0.843). There was a significant correlation between the vector difference between preoperative and postoperative posterior astigmatism and the change in corneal pachymetry (rP = 0.47, P = 0.010). Conclusions. Posterior corneal astigmatism (especially the orientation) and therefore the relationship between anterior and total corneal astigmatism may change after DMEK. This should be considered to improve the accuracy of toric IOL power calculations following phakic DMEK or in combined procedures.

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Section: Discussionmentioning

confidence: 99%

Changes in Anterior, Posterior, and Total Corneal Astigmatism after Descemet Membrane Endothelial Keratoplasty

Alnawaiseh

Zumhagen

Rosentreter

et al. 2017

Journal of Ophthalmology

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“…The changed corneal power and the hyperopic shift after triple DMEK have been described in various studies in the literature [ 7 – 9 ]. Both Schoenberg et al and our group showed that the anterior curvature did not significantly change after DMEK [ 8 , 9 ]. Morphological changes in posterior curvature of the cornea are to be expected after DMEK, because DMEK surgery acts mainly on the backside of the cornea.…”

Section: Discussionmentioning

confidence: 91%

“…Given the promise of near complete visual recovery and refractive stability over time with this procedure [ 7 , 22 ], increasing interest is being focused on IOL power calculations for cataract surgery prior to, in the same setting or after DMEK. In clinical practice, hyperopic outcomes tend to occur after endothelial keratoplasty and in the past many surgeons have aimed to achieve a more myopic postoperative outcome and choose a refractive target of −0.75 to −1.00 D to reduce the chance of unintended hyperopic surprises [ 8 , 11 , 24 ].…”

Section: Discussionmentioning

confidence: 99%

“…This allows faster visual rehabilitation, improved visual acuity and improved corneal transparency [ 2 – 6 ]. Refractive change after DMEK has been described as slight [ 7 , 8 ], Ham et al showing a refractive change in spherical equivalent at 6 months post DMEK of +0.32 ± 1.01 diopter [ 7 ]. They propose that the hyperopic shift results from a reversal of a preceding myopic shift induced by stromal swelling in endothelial disease [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

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Intraocular lens power calculation using standard formulas and ray tracing after DMEK in patients with Fuchs endothelial dystrophy

et al. 2017

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BackgroundThe study presented here aims to optimize the accuracy of intraocular lens (IOL) power calculations in patients after DMEK by evaluation of the impact of the altered anterior/posterior corneal curvature relationship.MethodsScheimpflug-based Oculus Pentacam imaging was performed after DMEK surgery for Fuchs endothelial dystrophy. The IOL power was calculated for all patients by ray tracing, aiming for postoperative emmetropia. We also performed the IOL calculation using four third-generation formulas (SRK-T, Hoffer-Q, Holladay-1 and Haigis). The residual refractions for the individual target IOL were compared and analyzed.ResultsThis retrospective study included 42 eyes of 33 patients (age 68.73 ± 10.11 years) after DMEK surgery. The differences between the expected residual refraction based on ray tracing and that predicted with the third-generation formulas were statistically significant (all formulas p < 0.001). The highest mean difference in the residual refraction between the target IOL measured by ray tracing and that calculated with third-generation formulas was found for the Haigis formula (0.90 ± 0.40 D), and the lowest mean difference for the SRK/T formula (0.73 ± 0.49 D).ConclusionsDMEK surgery induced a relevant change in the anterior to posterior corneal curvature relationship; this needs to be taken into account in the IOL power calculation to avoid hyperopic refractive surprises.

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“…Forty percent of patients will get a slightly myopic shift, and 60% of patients will get a hyperopic shift. The induced refractive shifts range from −0.5 to +2.0 D.[23]Once you master the DMEK with simple corneal edema, you can perform more complex cases, such as cases with a failed PK, or advanced cases with pseudophakic bullous keratoplastyIn cases with very edematous cornea, remove the thick epithelium from the swollen cornea to improve your view. Perform DMEK in more challenging cases with a very swollen cornea when you are comfortable with the procedureAvoid eyes which had previous vitrectomy, filtration surgeries, AC-IOL implantation, etc.…”

Section: Suggestions For the Beginnermentioning

confidence: 99%

Step-by-step Descemet's membrane endothelial keratoplasty surgery

Chen

Terry

2019

Taiwan J Ophthalmol

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With the success of Descemet's stripping automated endothelial keratoplasty (DSAEK) technique providing better outcomes in visual prognosis and theoretically lower rejection rate than penetrating keratoplasty, DSAEK dominated the realm of endothelial keratoplasty for the past decade. However, Descemet's membrane endothelial keratoplasty (DMEK) has become more and more popular worldwide due to its even lower rejection rate, faster visual recovery, better visual outcome, and lower long-term endothelial loss. In this article, we demonstrate the techniques and nuances of DMEK surgery in detail for corneal specialists who are beginning their DMEK surgeries.

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Refractive outcomes of Descemet membrane endothelial keratoplasty triple procedures (combined with cataract surgery)

Abstract: No author has a financial or proprietary interest in any material or method mentioned.

Cited by 91 publications

References 23 publications

Changes in Anterior, Posterior, and Total Corneal Astigmatism after Descemet Membrane Endothelial Keratoplasty

Changes in Anterior, Posterior, and Total Corneal Astigmatism after Descemet Membrane Endothelial Keratoplasty

Intraocular lens power calculation using standard formulas and ray tracing after DMEK in patients with Fuchs endothelial dystrophy

Step-by-step Descemet's membrane endothelial keratoplasty surgery

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