Triple-Dmek And Iol Power Calculation: A Comparison Of Biometric Devices And Formulas
Published 2025 - 43rd Congress of the ESCRS
Reference: FP31.02 | Type: Free paper | DOI: 10.82333/2y2z-xs42
Authors: Ferdinando Cione* 1 , Maddalena De Bernardo 2 , Margherita Di Stasi 3 , Martina De Luca 2 , Matteo Savo 2 , Stefano Gallo 2 , Marco Gioia 4 , Nicola Rosa 2
1University Eye Unit, Department of Medicine Surgery and Dentistry ,University of Salerno,Salerno,Italy;University Eye Clinic,AOU San Giovanni di Dio e Ruggi D'Aaragona,Salerno,Italy, 2University Eye Unit, Department of Medicine Surgery and Dentistry ,University of Salerno,Salerno,Italy, 3Eye Unit,PO San Luca, Vallo della Lucania,Vallo della Lucania,Italy, 4Eye Unit,PO Maria SS Addolorata,Eboli,Italy;University Eye Unit, Department of Medicine Surgery and Dentistry ,University of Salerno,Salerno,Italy
Purpose
The combination of Descemet membrane endothelial keratoplasty (DMEK) and cataract surgery (triple-DMEK) has become a standard treatment for patients suffering from both Fuchs’ corneal dystrophy and cataract. Despite the known hyperopic shift, choosing an appropriate intraocular lens (IOL) for these patients remains challenging. Our aim is to compare different IOL calculation formulas and two biometric devices to identify the best match between expected and actual postoperative refraction after triple-DMEK.
Setting
Prospective cohort study.
Methods
We prospectively included patients who underwent primary triple-DMEK. Preoperative IOL calculation was performed using the ANTERION swept-source OCT biometer and the IOLMaster 700 optical biometer. The choice of IOL was based on the surgeon’s experience and subjective assessment of the expected hyperopic shift. The same monofocal one-piece IOL was implanted in all patients. Outcome measures collected at the six-month follow-up included best corrected visual acuity (BCVA), spherical equivalent (SE), pachymetry (Pentacam), and the necessity of further surgical interventions. The latest postoperative spherical equivalent and the expected refraction based on the biometry were compared using a Bland-Altman plot.
Results
A total of 29 eyes from 24 patients (21 females, mean age 70.2 ± 8.01 years) have been analyzed so far (preliminary results). The median preoperative BCVA (logMAR) was 0.3 (IQR 0.4–0.2), and the mean preoperative pachymetry was 595 ± 44 µm. The median postoperative BCVA (logMAR) was 0.00 (IQR 0.1–0.00), and the mean postoperative pachymetry was 546 ± 49 µm. The mean difference between preoperatively calculated and postoperative SE was as follows: -0.27 ± 0.77 D for Anterion_SRK/T; -0.47 ± 0.76 D for IOLMaster_SRK/T; -0.69 ± 0.78 D for Anterion_Okulix; -0.89 ± 0.7 D for IOLMaster_Okulix; -0.13 ± 0.74 D for Anterion_Haigis; -0.40 ± 0.73 D for IOLMaster_Haigis; -0.15 ± 0.73 D for Anterion_HofferQ; -0.41 ± 0.69 D for IOLMaster_HofferQ.
Conclusions
Triple-DMEK is an effective method for the treatment of endothelial disease and lens opacity. All tested IOL calculation formulas on both biometry devices lead to a postoperative hyperopic shift, suggesting an underestimation of the effective IOL power needed. This effect increases the more the corneal thickness decreases after a successful DMEK. The difference between preoperatively calculated and postoperative SE was smaller when IOL power was assessed using the Anterion biometer compared to the IOLMaster.