Abstract
Purpose. To evaluate changes in anterior, posterior, and total corneal astigmatism in patients after Descemet membrane endothelial keratoplasty (DMEK). Methods. We retrospectively included 29 eyes of 23 patients (age 67.6 ± 9.8 years, 13 female, 10 male) after DMEK surgery. The magnitude and axis orientation of anterior, posterior, and total corneal astigmatism before and after DMEK were determined using a rotating Scheimpflug system (Pentacam HR, Oculus). Results. The magnitude of anterior, posterior, and total corneal astigmatism in the central cornea did not change significantly after surgery. Before surgery, we found a significant correlation between the magnitudes of anterior and posterior corneal astigmatism (Spearman's correlation coefficient (rS) = 0.526, P = 0.003), while after surgery this correlation was no longer significant (rS = 0.038, P = 0.843). There was a significant correlation between the vector difference between preoperative and postoperative posterior astigmatism and the change in corneal pachymetry (rP = 0.47, P = 0.010). Conclusions. Posterior corneal astigmatism (especially the orientation) and therefore the relationship between anterior and total corneal astigmatism may change after DMEK. This should be considered to improve the accuracy of toric IOL power calculations following phakic DMEK or in combined procedures.
Highlights
With advantages such as a lower risk of rejection, faster visual rehabilitation, improved visual outcome, and refractive stability after Descemet membrane endothelial keratoplasty (DMEK) [1,2,3,4,5], DMEK surgery is becoming an increasingly popular option for the treatment of Fuchs’ endothelial dystrophy (FED) [6, 7]
Owing to the excellent visual outcome and refractive stability achieved after DMEK [5, 12], intraocular lenses (IOLs) power calculations in patients after phakic DMEK or within the setting of the new triple procedure are becoming a topic of much interest in clinical practice [18, 19]
Toric IOL power calculations based on the anterior corneal curvature, ignoring posterior corneal astigmatism, can over- or underestimate total corneal astigmatism [20,21,22,23,24]
Summary
With advantages such as a lower risk of rejection, faster visual rehabilitation, improved visual outcome, and refractive stability after DMEK [1,2,3,4,5], DMEK surgery is becoming an increasingly popular option for the treatment of Fuchs’ endothelial dystrophy (FED) [6, 7]. Cataract surgery and implantation of toric intraocular lenses (IOLs) are often performed to correct corneal astigmatism, resulting in satisfactory spectacle-free visual outcomes. Wacker et al showed relevant changes in corneal astigmatism based on asymmetric corneal swelling in the course of FED and demonstrated differences compared with the normal population at different stages of the disease [10]. During the new triple procedure with toric IOL implantation, the corneal shape, especially of the posterior corneal curvature, can be expected to change [5, 11]. This may affect the accuracy of toric IOL power calculations
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