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Session Title: Cornea surgical I
Session Date/Time: Tuesday 08/10/2013 | 08:00-10:30
Paper Time: 09:42
Venue: Forum (Ground Floor)
First Author: : J.Parker USA
Co Author(s): : K. Van Dijk V. Liarakos L. Ham L. Frank G. Melles
To evaluate the incidence and causes of anterior corneal surface irregularities after successful Descemet membrane endothelial keratoplasty (DMEK), as well as the efficacy of contact lens fitting in these cases.
Non-randomized, prospective clinical study, at a tertiary referral center. Netherlands Institute for Innovative Ocular Surgery, Rotterdam
In a series of 262 successful DMEK surgeries, 23 eyes (21 patients) were fitted with a contact lens for subnormal visual outcome or monocular diplopia. These cases were evaluated with Pentacam imaging before and at six months after surgery, and outcome data were compared with a randomly selected DMEK control group (n=23).
Indications for contact lens fitting included: (1) Obvious corneal surface irregularities due to pre-existing corneal scarring (Group I), (2) surface irregularities associated with longstanding preoperative stromal edema (Group II), and (3) undetectable optical imperfections (Group III). Postoperative best spectacle corrected visual acuity (BSCVA) improved after contact lens correction (P<0.001). Pre- and postoperative Pentacam irregularity indices were significantly higher in the contact lens group than in the DMEK control group (P<0.05). Positive correlations were found between the duration of pre-operative stromal edema and postoperative Pentacam indices (P<0.02).
After successful DMEK, 9% (23/262) of eyes showed subnormal BSCVA and/or monocular diplopia due to corneal scarring, surface irregularities or undetectable optical imperfections, which could be managed by contact lens fitting. Prolonged preoperative corneal edema for > 12 months may be a risk factor for diffuse irregular astigmatism after DMEK.
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