title: Refractive outcomes of Descemet membrane endothelial keratoplasty triple procedures (combined with cataract surgery).
abstract: OBJECTIVE
  To describe the refractive outcomes of triple Descemet membrane endothelial keratoplasty (DMEK).
  
  
  METHODS
  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.
  
  
  BACKGROUND
  No author has a financial or proprietary interest in any material or method mentioned.
authors.affiliation: From the Price Vision Group (Schoenberg, F.W. Price, Miller, McKee) and the Cornea Research Foundation of America (M.O. Price), Indianapolis, Indiana, USA.
authors.forename: Evan D
authors.initials: ED
authors.lastname: Schoenberg
authors.affiliation: From the Price Vision Group (Schoenberg, F.W. Price, Miller, McKee) and the Cornea Research Foundation of America (M.O. Price), Indianapolis, Indiana, USA.
authors.forename: Francis W
authors.initials: FW
authors.lastname: Price
authors.affiliation: From the Price Vision Group (Schoenberg, F.W. Price, Miller, McKee) and the Cornea Research Foundation of America (M.O. Price), Indianapolis, Indiana, USA.
authors.forename: Jalee
authors.initials: J
authors.lastname: Miller
authors.affiliation: From the Price Vision Group (Schoenberg, F.W. Price, Miller, McKee) and the Cornea Research Foundation of America (M.O. Price), Indianapolis, Indiana, USA.
authors.forename: Yuri
authors.initials: Y
authors.lastname: McKee
authors.affiliation: From the Price Vision Group (Schoenberg, F.W. Price, Miller, McKee) and the Cornea Research Foundation of America (M.O. Price), Indianapolis, Indiana, USA. Electronic address: marianneprice@pricevisiongroup.net.
authors.forename: Marianne O
authors.initials: MO
authors.lastname: Price
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001251:Astigmatism / Q000503:physiopathology; D002386:Cataract / Q000150:complications / Q000503:physiopathology; D003315:Cornea / Q000503:physiopathology; D057111:Descemet Stripping Endothelial Keratoplasty; D005260:Female; D005642:Fuchs' Endothelial Dystrophy / Q000150:complications / Q000503:physiopathology; D006801:Humans; D007368:Interferometry; D019654:Lens Implantation, Intraocular; D008027:Light; D008297:Male; D008875:Middle Aged; D018918:Phacoemulsification; D012029:Refraction, Ocular / Q000502:physiology*; D012189:Retrospective Studies; D014792:Visual Acuity / Q000502:physiology*