Adjusting The Refractive Target In Cataract Surgery Prior To Dmek
Published 2025 - 43rd Congress of the ESCRS
Reference: PP25.03 | Type: Poster | DOI: 10.82333/pryb-hv57
Authors: Apostolos Lazaridis* 1 , Bodgan Spiru 2 , Elefterios Giallouros 2 , Walter Sekundo 2 , Anke Messerschmidt-Roth 2 , Konstantinos Droutsas 3
1Department of Ophthalmology,Philipps University of Marburg,Marburg,Germany;Ophthalmology Center Volos,Volos,Greece, 2Department of Ophthalmology,Philipps University of Marburg,Marburg,Germany, 3Department of Ophthalmology,Philipps University of Marburg,Marburg,Germany;First Department of Ophthalmology,National and Kapodistrian University of Athens,Athens,Greece
Purpose
To predict the amount of hyperopic shift after uneventful Descemet membrane endothelial keratoplasty (DMEK) in pseudophakic eyes based on changes of total corneal refractive power (TCRP) and central corneal thickness (CCT) and establish a predictive model for more accurate refractive targets in cataract surgery prior to DMEK
Setting
Department of Ophthalmology, Philipps University of Marburg, Germany
Methods
Sixty pseudophakic eyes, which underwent DMEK without intraoperative and postoperative complications, were included. The TCRP mean keratometry values (Km) at 2, 4, 6 and 8mm zones and the CCT were evaluated. The measurements were performed preoperatively and at 3, 6, 12, 24 and 60 months postoperatively. The correlations between the changes of TCRP and CCT were investigated over the postoperative course.
Results
The TCRP Km showed in all zones a significant decrease (hyperopic shift) at 3 months (P<0.001), followed by a continuous and significant increase (myopic shift) up to 60 months (P<0.001). A decrease of CCT was observed up to 6 months (P<0.001), followed by a continuous increase thereafter (P<0.001). A significant positive correlation between the decrease of CCT and the decrease of TCRP Km at 2, 4, 6 and 8mm zones (preoperative – 3-month values; P<0.001; r ranging from 0.553 to 0590) was found. For the optically relevant 4mm zone the equation of the linear regression model for the expected TCRP Km decrease (y) in relation with the decrease of CCT (preoperative – 3-month postop) (x) was y= 0.0115x + 0.1264.
Conclusions
Our study quantified objectively the hyperopic shift after DMEK. To date, in cataract surgery prior to DMEK or in triple DMEK procedures, in order to achieve emmetropia the refractive target would be set to low myopia (-0.50 Diopters) based on clinical experience rather than measurable data. The postoperative TCRP reduction suggested from our TCRP/CCT regression analysis model could enable a better prediction of the post-DMEK hyperopic shift and more accurate adjustments of the refractive target. Historical data of CCT prior to the development of a clinically significant corneal edema would enable prior to DMEK an estimation of the post-DMEK CCT of the dehydrated cornea and therefore an estimation of the expected post-DMEK decrease of CCT.