title: [Refractive changes in triple Descemet membrane endothelial keratoplasty].
abstract: BACKGROUND
  A hyperopic shift, i.e. a shift of refraction in the direction of plus values, in Descemet membrane endothelial keratoplasty (DMEK) is a well-known phenomenon. Because of the need to select an appropriate intraocular lens power this becomes particularly relevant in triple DMEK, which is a combination of DMEK and cataract surgery.
  
  
  OBJECTIVE
  In this study the refractive changes induced by triple DMEK were evaluated. The underlying mechanisms were classified based on corneal topographical data.
  
  
  METHODS
  The study involved a retrospective evaluation of 29 eyes from 26 patients who underwent triple DMEK. The preoperative and postoperative refractions were compared with the initially desired target refraction. Calculations concerning refractive power were performed using corneal topographical data and the Gullstrand formula.
  
  
  RESULTS
  On average a hyperopic shift was observed. The operation led to steepening of the posterior corneal surface and flattening of the anterior corneal surface. Both resulted in a reduction of corneal refractive power but changes of the posterior corneal surface were identified as the most important factor. Those patients in whom both eyes had been operated on, showed very similar postoperative topography for both eyes, irrespective of the preoperative values.
  
  
  CONCLUSIONS
  The observed hyperopic shift was a mean value. A prediction of refraction in the individual cases by means of the available parameters was not possible. In general, the selection of an intraocular lens with a stronger myopic target refraction than that for standard cataract surgery is recommended.
authors.affiliation: Klinik und Poliklinik für Augenheilkunde, Universitätsklinikum Leipzig, Liebigstraße 10-14, 04103, Leipzig, Deutschland. christian.girbardt@medizin.uni-leipzig.de.
authors.forename: C
authors.initials: C
authors.lastname: Girbardt
authors.affiliation: Klinik und Poliklinik für Augenheilkunde, Universitätsklinikum Leipzig, Liebigstraße 10-14, 04103, Leipzig, Deutschland.
authors.forename: N
authors.initials: N
authors.lastname: Oertel
authors.affiliation: Klinik und Poliklinik für Augenheilkunde, Universitätsklinikum Leipzig, Liebigstraße 10-14, 04103, Leipzig, Deutschland.
authors.forename: J
authors.initials: J
authors.lastname: Adamek-Dyk
authors.affiliation: Klinik und Poliklinik für Augenheilkunde, Universitätsklinikum Leipzig, Liebigstraße 10-14, 04103, Leipzig, Deutschland.
authors.forename: P
authors.initials: P
authors.lastname: Wiedemann
authors.affiliation: Klinik und Poliklinik für Augenheilkunde, Universitätsklinikum Leipzig, Liebigstraße 10-14, 04103, Leipzig, Deutschland.
authors.forename: A
authors.initials: A
authors.lastname: Nestler
mesh_terms: D000368:Aged; D002386:Cataract / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D003131:Combined Modality Therapy / Q000379:methods*; D057111:Descemet Stripping Endothelial Keratoplasty / Q000379:methods*; D006801:Humans; D019654:Lens Implantation, Intraocular / Q000379:methods*; D008297:Male; D016343:Monitoring, Intraoperative / Q000379:methods; D018918:Phacoemulsification / Q000379:methods*; D012030:Refractive Errors / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D012189:Retrospective Studies; D016896:Treatment Outcome; D014792:Visual Acuity
keywords: Cataract surgery; Cornea; Descemet membrane endothelial keratoplasty; Intraocular lens; Refraction