title: Two-Year Refractive Outcomes After Descemet Membrane Endothelial Keratoplasty.
abstract: OBJECTIVE
  To monitor refractive changes after Descemet membrane endothelial keratoplasty (DMEK) and to determine what may influence these changes and the time point of stabilization.
  
  
  METHODS
  From 67 pseudophakic DMEK eyes operated on for Fuchs endothelial dystrophy at a tertiary referral center, biomicroscopy, visual acuity, subjective refraction, and Scheimpflug-based corneal tomography data were obtained before and up to 2 years postoperatively. Visual acuity and changes in spherical equivalent (SE), mean anterior and posterior simulated keratometry (Km), and central pachymetry were analyzed.
  
  
  RESULTS
  At 3 months postoperatively, both hyperopic (28/67 eyes) and myopic (21/67 eyes) shifts were observed; 18/67 eyes showed no SE change. The mean change in SE at 3 months was +0.33 diopters (D) (95% confidence interval = [0.11, 0.54], P = 0.028), which stabilized thereafter (P > 0.466). Initial flattening of mean anterior Km by 0.66D (95% confidence interval = [-0.81, -0.51], P < 0.001) at 3 months was followed by a slow steepening, which became significant between 1 and 2 years postoperatively (P < 0.001). Posterior Km stabilized after 3 months (P > 0.252). Preoperative to 3 months postoperative absolute changes in anterior Km were positively related to preoperative backscattered light from the central anterior cornea (P = 0.035), and the presence of partial graft detachment postoperatively (P = 0.013).
  
  
  CONCLUSIONS
  After DMEK, SE and posterior corneal curvature were on average stable at 3 months after surgery, whereas the mean anterior corneal curvature showed an ongoing gradual change. Changes in anterior corneal curvature may be related to preoperative anterior corneal densitometry or postoperative partial graft detachment.
authors.affiliation: *Netherlands Institute for Innovative Ocular Surgery, Rotterdam, the Netherlands;†Melles Cornea Clinic Rotterdam, Rotterdam, the Netherlands;‡Hospital Regional Universitario Málaga, Spain; and§Amnitrans EyeBank Rotterdam, Rotterdam, the Netherlands.
authors.forename: Korine
authors.initials: K
authors.lastname: van Dijk
authors.forename: Marina
authors.initials: M
authors.lastname: Rodriguez-Calvo-de-Mora
authors.forename: Hilde
authors.initials: H
authors.lastname: van Esch
authors.forename: Laurence
authors.initials: L
authors.lastname: Frank
authors.forename: Isabel
authors.initials: I
authors.lastname: Dapena
authors.forename: Lamis
authors.initials: L
authors.lastname: Baydoun
authors.forename: Silke
authors.initials: S
authors.lastname: Oellerich
authors.forename: Gerrit R J
authors.initials: GR
authors.lastname: Melles
mesh_terms: D000368:Aged; D003315:Cornea / Q000503:physiopathology*; D063171:Corneal Pachymetry; D019781:Corneal Topography; D057111:Descemet Stripping Endothelial Keratoplasty; D005260:Female; D005500:Follow-Up Studies; D005642:Fuchs' Endothelial Dystrophy / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D019654:Lens Implantation, Intraocular; D008297:Male; D008875:Middle Aged; D018918:Phacoemulsification; D011446:Prospective Studies; D019591:Pseudophakia / Q000209:etiology; D012029:Refraction, Ocular / Q000502:physiology*; D012030:Refractive Errors / Q000503:physiopathology*; D014792:Visual Acuity / Q000502:physiology