Refractive outcomes of Descemet membrane endothelial keratoplasty triple procedures (combined with cataract surgery).

PURPOSE: To describe the refractive outcomes of triple Descemet membrane endothelial keratoplasty (DMEK).

DESIGN: Retrospective case series.

METHODS: The study included patients with Fuchs endothelial dystrophy and cataract without coincident pathology.

RESULTS: Outcomes of 108 sequential triple DMEK procedures were evaluated. With a mean follow-up of 11.9 months, the median corrected distance visual acuity (CDVA) was 20/20 (range 20/15 to 20/40) and the median uncorrected distance visual acuity in eyes with a distance target (n = 84) was 20/40 (range 20/20 to 20/200). Forty-five percent of patients gained 3 or more lines of CDVA. The median refractive error was +0.43 diopter (D) (interquartile range, -0.34 to +1.17 D). Aspheric intraocular lenses (IOLs) (n = 91) did not significantly change refractive astigmatism (mean: preoperative +0.926 D ± 0.144 [SD]; postoperative +0.945 ± 0.129 D) (P = .83), while toric IOLs (n = 9) did (mean: preoperative +2.47 ± 0.36 D; postoperative +0.94 ± 0.90 D) (P = .0015). The anterior curvature measured by Scheimpflug imaging (Pentacam) did not significantly change (mean -0.06 ± 0.47) (P = .41); however, keratometry by partial coherence interferometry (IOLMaster) did (mean -0.6 ± 0.9 D) (P < .0001).

CONCLUSIONS: Triple DMEK safely achieved excellent CDVA. Selection of the optimum IOL power is complicated by several factors. Because Fuchs dystrophy induces changes predominately in the central cornea, measurements averaging curvature over a larger area might underreport significant refractive deviations. In the absence of an algorithm to more precisely individualize IOL calculations, a refractive target of -0.75 to -1.00 D will help reduce the proportion of eyes left hyperopic.

FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.