Refractive Stability 1-Year After DMEK Triple Procedure

Sunday, April 19, 2015: 3:06 PM
Room 5A (San Diego Convention Center)
Christopher S. Sales, MD, MPH
Mark A. Terry, MD
Zachary M. Mayko, MS
Michael D. Straiko, MD

To investigate refractive stability between 6- and 12-months after the DMEK triple-procedure.

Six and 12-month manifest refractions and Scheimpflug tomography were measured for consecutive DMEK triple-procedures performed on eyes with Fuch’s endothelial dystrophy with our standardized technique (i.e. pre-stripped tissue with or without a pre-marked S-Stamp from our eye bank, over-stripping the recipient, a Straiko glass injector, a no-touch tap technique, and bubble of 20% SF6 gas). Best-spectacle corrected visual acuity was measured using a Snellen projector system.

We analyzed a consecutive series of 14 eyes from the same center that had undergone a DMEK triple-procedure and had both 6- and 12-month manifest refractions. Mean central corneal thickness (CCT) decreased from 622±47 to 534±37 µm between the preoperative and 6-month visits (P<0.001), and further decreased to 525±31 µm between the 6- and 12-month visits (P=0.18). The mean spherical equivalent (SE) exhibited a hyperopic shift between 6 and 12 months (-0.29±0.71 vs. -0.18±0.62 diopters [D], P<0.001), but there were no statistically significant changes in mean anterior corneal curvature (43.58±1.09 vs. 43.58±1.08 D, P=0.99) or mean posterior corneal curvature (-6.32±0.29 vs. -6.32±0.28 D, P=0.99) during this time interval.

Early experience with the DMEK Triple suggests that the cornea continues to deturgesce slightly between 6 and 12 months, resulting in a clinically insignificant hyperopic shift. 6-months may be a reasonable time point for measuring the efficacy of IOL lens targets as well as developing a nomogram for this procedure in the future.