title: Refractive change and stability after Descemet membrane endothelial keratoplasty. Effect of corneal dehydration-induced hyperopic shift on intraocular lens power calculation.
abstract: OBJECTIVE
  To determine the refractive change and stability of the transplanted cornea after Descemet membrane endothelial keratoplasty (DMEK) through a 3.0 mm clear corneal incision.
  
  
  METHODS
  Tertiary referral center.
  
  
  METHODS
  Cohort study.
  
  
  METHODS
  Subjective and objective refractive data from pseudophakic eyes were obtained before and 3 and 6 months after DMEK.
  
  
  RESULTS
  The study comprised 50 eyes, 7 were phakic and 43 pseudophakic. Six months postoperatively, the corrected distance visual acuity was 20/25 (0.8) or better in 38 eyes (74%). The mean increase in spherical equivalent at 6 months (N = 50) was +0.32 diopter (D) ± 1.01 D (SD) (P=.0304) and in refractive cylinder, -0.48 ± 1.02 D (P=.001). Although Scheimpflug imaging showed a stable anterior corneal curvature, the posterior curvature increased from 5.50 ± 0.5 D preoperatively to 6.40 ± 0.4 D at 6 months and pachymetry decreased from 672 ± 82 μm to 540 ± 59 μm, respectively (both N = 32) (both P=.000).
  
  
  CONCLUSIONS
  After DMEK, a slight preoperative to postoperative refractive change and stabilization at 3 months occurred that may induce a hyperopic shift that was not the result of the negative lenticule effect of DSEK/DSAEK. Thus, in DMEK, the hyperopic shift may result from a reversal of a preceding myopic shift induced by stromal swelling in endothelial disease. If so, normal intraocular power nomograms apply for cataract surgery before or during DMEK.
authors.affiliation: Netherlands Institute for Innovative Ocular Surgery, Rotterdam, The Netherlands.
authors.forename: Lisanne
authors.initials: L
authors.lastname: Ham
authors.forename: Isabel
authors.initials: I
authors.lastname: Dapena
authors.forename: Kyros
authors.initials: K
authors.lastname: Moutsouris
authors.forename: Chandra
authors.initials: C
authors.lastname: Balachandran
authors.forename: Laurence E
authors.initials: LE
authors.lastname: Frank
authors.forename: Korine
authors.initials: K
authors.lastname: van Dijk
authors.forename: Gerrit R J
authors.initials: GR
authors.lastname: Melles
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003315:Cornea / Q000503:physiopathology*; D019781:Corneal Topography; D057111:Descemet Stripping Endothelial Keratoplasty; D003890:Desiccation; D005260:Female; D006801:Humans; D006956:Hyperopia / Q000209:etiology / Q000503:physiopathology*; D019654:Lens Implantation, Intraocular; D007910:Lenses, Intraocular; D008297:Male; D008875:Middle Aged; D049451:Nomograms; D055095:Optics and Photonics; D018918:Phacoemulsification; D011183:Postoperative Complications; D011446:Prospective Studies; D019591:Pseudophakia / Q000209:etiology / Q000503:physiopathology; D012029:Refraction, Ocular / Q000502:physiology*; D014792:Visual Acuity / Q000502:physiology