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Analysis of posterior donor corneal parameters 1 year after Descemet stripping automated endothelial keratoplasty (DSAEK) triple procedure

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Abstract

Background

Although Descemet stripping automated endothelial keratoplasty (DSAEK) was demonstrated to be effective for the treatment of endothelial corneal diseases, a variable hyperopic shift has been measured as a common occurrence postoperatively. The aim of this work was to investigate the variance in the corneal and refractive responses to DSAEK combined with phacoemulsification and implantation of intra-ocular lens (IOL), namely the DSAEK triple procedure.

Methods

The refractive, topographic, and anterior segment optical coherence tomography (AS-OCT) data of 23 eyes treated with DSAEK triple procedure were analyzed. A mean refractive IOL target of –1.04 ± 0.09 D was calculated based on empirical data of our early experience to achieve emmetropia in all the eyes included in the study. Donor corneal parameters, i.e., graft diameter, thickness, and profile, were investigated in order to verify their possible role in the variable refractive shift after DSAEK.

Results

Although the 1-year mean refractive outcome was close to emmetropia (–0.01 ± 0.89 D), the average difference between the targeted postoperative refraction and the 1-year postoperative spherical equivalent refraction was +0.98 ± 0.87 D. Correlations of refractive change with central graft thickness (r = 0.36, p = 0.05) and graft diameter (r = 0.45; p = 0.03) were statistically significant. AS-OCT analysis revealed how the graft shape, with graft thicker in the periphery compared with the center, contributed to reduce the radius of curvature of the posterior cornea, thus favoring the hyperopic shift postoperatively.

Conclusions

DSAEK triple procedure provides negligible changes in the surface topography, however with a variable amount of hyperopic shift postoperatively. Central graft thickness and graft profile together contributed to approximately two-thirds of the variance in refractive shift postoperatively. Lenticule diameter provided a minor influence on postoperative hyperopic shift than other graft parameters.

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Disclosure

Dr. Terry has a financial interest in the specialized instruments used in this surgery. The remaining authors have no financial or commercial interests in the materials presented herein.

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Authors and Affiliations

  1. Vision Engineering, Rome, Italy

    Marco Lombardo & Giuseppe Lombardo

  2. Corneal Services, Devers Eye Institute, Portland, OR, USA

    Mark A. Terry

  3. Lions Vision Research Laboratory of Oregon, Portland, OR, USA

    Mark A. Terry & David D. Boozer

  4. CNR-INFM LiCryL Laboratory, Department of Physics, University of Calabria, Rende (CS), Italy

    Giuseppe Lombardo

  5. SerraoLaser, Rome, Italy

    Sebastiano Serrao

  6. IRCCS Fondazione G.B. Bietti, Rome, Italy

    Marco Lombardo & Pietro Ducoli

  7. Via Adda 7, 00198, Rome, Italy

    Marco Lombardo

Authors
  1. Marco Lombardo
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  2. Mark A. Terry
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  3. Giuseppe Lombardo
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  4. David D. Boozer
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  5. Sebastiano Serrao
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  6. Pietro Ducoli
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Correspondence to Marco Lombardo.

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Lombardo, M., Terry, M.A., Lombardo, G. et al. Analysis of posterior donor corneal parameters 1 year after Descemet stripping automated endothelial keratoplasty (DSAEK) triple procedure. Graefes Arch Clin Exp Ophthalmol 248, 421–427 (2010). https://doi.org/10.1007/s00417-009-1284-2

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  • DOI: https://doi.org/10.1007/s00417-009-1284-2

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