The aim of this study was to check the refractive outcomes in patients with Fuchs endothelial dystrophy of Descemet membrane endothelial keratoplasty combined with cataract surgery (DMEK triple).
The analysis was done retrospectively of 68 eyes belonging to the 68 patients with Fuchs endothelial dystrophy who underwent DMEK triple.
The mean age of patients was 66.5 ± 8.6 years, and 65% (44 of 68) were female. Mean target refraction was −0.69 diopters (D) (interquartile range: −0.80 to −0.50 D). At 6 months, 47% (32 of 68) and 63% (43 of 68) of eyes were within ±0.50 and ±1.00 D of target refraction, respectively. Among eyes greater than 0.50 D from target, 78% (28 of 36) were hyperopic surprises. Mean spherical equivalent at 6 months was −0.14 ± 1.26 D, representing a mean hyperopic shift of 0.55 D from target. Preoperative pachymetry was higher in eyes with greater than 0.50 D of hyperopic surprise (648 ± 60 vs 613 ± 49 µm, P = .04). Refractive shift was greater in eyes with a preoperative central corneal thickness of 640 µm or greater versus eyes with a central corneal thickness of less than 640 µm (+1.20 ± 0.92 vs +0.40 ± 0.99 D, P = .02). None of the eyes with a preoperative central corneal thickness of 640 µm or greater shifted myopically compared to target (range: −0.09 to +2.89 D). A mean hyperopic shift of 0.55 D from target refraction occurred after DMEK triple, and 47% of eyes were within 0.50 D of target refraction at 6 months postoperatively.
The study concluded that the thicker corneas preoperatively had greater hyperopic shift. A greater myopic target refraction may be warranted in eyes with a preoperative central corneal thickness of 640 µm or greater.