title: Refractive error after cataract surgery combined with descemet stripping automated endothelial keratoplasty.
abstract: OBJECTIVE
  To assess refractive error after cataract surgery combined with Descemet stripping automated endothelial keratoplasty using adjusted keratometric (K) readings to calculate intraocular lens (IOL) power.
  
  
  METHODS
  Prospective, interventional case series.
  
  
  METHODS
  One eye of 39 consecutive patients with Fuchs endothelial dystrophy and cataract were included. To calculate IOL power before surgery, the Javal steep and flat K readings (Haag-Streeit) were adjusted by reducing their value by -1.19 diopters (D); the axial length was measured by immersion biometry, and the standard A-constant was used. Surgery included phacoemulsification, IOL (Acrysof SN60AT; Alcon) implantation within the capsular bag, and Descemet stripping automated endothelial keratoplasty using posterior lamella prepared with a 300-μm head microkeratome (Moria). The absolute prediction error (absolute difference between predicted and achieved refraction) was assessed 6 months after surgery.
  
  
  RESULTS
  The mean power of the implanted IOL was 23.22 ± 2.90 D. The mean predicted and achieved refractions were -0.27 ± 0.26 D and -0.23 ± 0.73 D, respectively. The mean absolute prediction error was 0.59 ± 0.42 D (range, 0.05 to -1.52 D). The postoperative spherical equivalent fell within ±0.50 D, ±1.00 D, and ±2.00 D of the predicted refraction in 55.5%, 83.3%, and 100% of cases, respectively. Had the IOL power been calculated without adjusting the K readings, the mean absolute prediction error would have been significantly higher (0.86 ± 0.62 D; P = .04).
  
  
  CONCLUSIONS
  In this study, in which posterior lamellae were prepared using a 300-μm head microkeratome, adjusting preoperative K readings by -1.19 D led to accurate IOL power calculation and highly predictable refractive error after cataract surgery combined with Descemet stripping automated endothelial keratoplasty.
authors.affiliation: Department of Clinical Physiopathology, Ophthalmology Institute, University of Turin, Turin, Italy.
authors.forename: Ugo
authors.initials: U
authors.lastname: de Sanctis
authors.forename: Francesco
authors.initials: F
authors.lastname: Damiani
authors.forename: Luca
authors.initials: L
authors.lastname: Brusasco
authors.forename: Federico
authors.initials: F
authors.lastname: Grignolo
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001699:Biometry; D002386:Cataract / Q000150:complications; D063171:Corneal Pachymetry; D019781:Corneal Topography; D057111:Descemet Stripping Endothelial Keratoplasty; D005260:Female; D005642:Fuchs' Endothelial Dystrophy / Q000150:complications; D006801:Humans; D019654:Lens Implantation, Intraocular; D007910:Lenses, Intraocular; D008297:Male; D033401:Microscopy, Acoustic; D008875:Middle Aged; D055095:Optics and Photonics; D018918:Phacoemulsification; D011183:Postoperative Complications; D011446:Prospective Studies; D012029:Refraction, Ocular / Q000502:physiology; D012030:Refractive Errors / Q000175:diagnosis* / Q000209:etiology*; D014792:Visual Acuity / Q000502:physiology