Refractive Changes After Triple Dmek Surgery In Fuchs Endothelial Corneal Dystrophy: Correlation With Preoperative Corneal Thickness And Densitometry

To evaluate refractive shifts following Descemet Membrane Endothelial Keratoplasty (DMEK) combined with cataract surgery (triple DMEK) and investigate their correlation with preoperative corneal densitometry and topographic central corneal thickness

Ankara Bilkent City Hospital, Single-center retrospective observational case series

A total of 30 eyes from 21 patients who underwent triple DMEK for Fuchs Endothelial Corneal Dystrophy at Ankara Bilkent City Hospital were included. Preoperative and 12-month postoperative visual acuity, endothelial cell density, and topographic parameters were recorded. The primary outcome was refractive shift, defined as the difference between predicted and actual postoperative refractive error. Preoperative central corneal thickness (CCT) and anterior-posterior corneal densitometry (Pentacam Oculus) were assessed for correlation with refractive shift.

The preoperative measurements of 30 eyes showed a best corrected visual acuity(BCVA) of 0,6 ± 1 logMAR,which improved to 0,1±1 logMAR at 12 months postoperatively (p=0,0),while the spherical equivalent shifted from 0.40 ± 1.80D preoperatively to -0.39 ± 1.20 D(p= 0,03 ) .CCT decreased from 655 ± 94 µm to 509 ± 39 µm (p=0,0) , donör endothelial cell density(ECD) decreased from 2795± 211 cells/mm² to 1303 ± 433 cells/mm²(p= 0,08).The predicted target refraction,calculated using the Barrett Unıversal II formula ,was -0.67 ± 0.2 D.At the 12-month follow-up,the average refractive shift was 0.24 ± 0.25 D(range:-1.40 to +3.10 D).No significant correlation was found between refractive shift and preoperative CCT or corneal densitometry measurements.

Achieving emmetropia in DMEK remains challenging, as our study observed a hyperopic shift despite targeting myopic intraocular lenses. Predicting refractive outcomes after combined DMEK surgery is inherently difficult, highlighting the need for a more precise approach to intraocular lens power selection. Therefore, in patients with Fuchs' endothelial dystrophy undergoing combined DMEK surgery, developing a reliable nomogram for lens power calculation is crucial. Further large-scale studies are necessary to identify factors influencing refractive shift and improve the predictability of postoperative refractive outcomes