Changes In Corneal Parameters After Descemet Membrane Endothelial Keratoplasty In Corneal Endothelial Failure Patients Secondary To Phakic Intraocular Lens Implantation

We aimed to assess (1) long-term clinical outcomes of patients diagnosed of bullous keratopathy due to phakic intraocular lens (pIOL) implantation, (2) changes of corneal curvature and refractive power after Descemet Membrane Endothelial Keratoplasty (DMEK) procedure.

Institutional, retrospective

We retrospectively analyzed 14 eyes of 13 patients who had undergone DMEK surgery between January 2019 and March 2023 due to corneal endothelial decompensation secondary to previous phakic IOL implantation. Anterior and posterior astigmatism, mean simulated keratometry (SimK), total corneal power(TCP), central corneal thickness(CCT), and endothelial cell count were examined before and after DMEK.

Mean posterior astigmatism at preoperative, postoperative 6 months, and 1 year period was -0.28±0.14D, -0.42±0.25D, -0.41±0.20D, respectively. Decrease in posterior astigmatism was significant from preoperative to postoperative 1 year (p=0.005), while the difference between postoperative 6 months and 1 year was not significant (p=0.932). No significant change was found in SimK, TCP, anterior corneal astigmatism, and both anterior and posterior corneal keratometry 1 year after DMEK (p>0.05). Improved best corrected visual acquity  (0.37±0.49 vs. 0.20±0.38 LogMAR, p=0.027), thinner CCT (555.92±57.63 vs. 524.62±43.62 μm, p=0.001), increased endothelial cell count (613±150 vs. 1656±857 cells/mm², p=0.006) were noted in postoperative setting.

DMEK is an effective surgical procedure for patients with bullous keratopathy due to phakic IOL in restoring corneal endothelial function. After DMEK procedure, alteration of posterior corneal astigmatism should be considered. Calculation of toric intraocular lens power is recommended after sufficient time of longer than 1 year for refractive stabilization.