Refractive Outcomes of Descemet Membrane Endothelial Keratoptasty Combined With Cataract Surgery in Fuchs Endothelial. Dystrophy

PURPOSE: To evaluate the refractive outcomes of Descemet membrane endothelial keratoplasty combined with cataract surgery (DMEK triple) in patients with Fuchs endothelial dystrophy. METHODS: A retrospective analysis of 68 eyes of 68 patients with Fuchs endothelial dystrophy who underwent DMEK triple between 2014 and 2018. RESULTS: The mean age of patients was 66.5 +/- 8.6 years, and 65% (44 of 681 were female. Mean target refraction was -0.69 diopters (D) (interquartite range: -0.80 to -0.50 D). At 6 months, 47% (32 of 68) and 63% (43 of 68) of eyes were within +/- 0.50 and +/- 1.00 D of target refraction, respectively. Among eyes greater than 0.50 D from target, 78% (28 of 36) were hyperopic surprises. Mean spherical equivalent at 6 months was -0.14 +/- 1.26 D, representing a mean hyperopic shift of 0.55 D from target. Preoperative pachymetry was higher in eyes with greater than 0.50 0 of hyperopic surprise (648 +/- 60 vs 613 +/- 49 pm, P = .04). Refractive shift was greater in eyes with a preoperative central corneal thickness of 640 mu m or greater versus eyes with a central corneat thickness of less than 640 mu m (+1.20 +/- 0.92 vs +0.40 +/- 0.99 D, P = .021. None of the eyes with a preoperative central corneal thickness of 640 mu m or greater shifted myopically compared to target (range: -0.09 to +2.89 D). CONCLUSIONS: A mean hyperopic shift of 0.55 D from target refraction occurred after DMEK triple, and 47% of eyes were within 0.50 D of target refraction at 6 months postoperatively. Thicker corneas preoperatively had greater hyperopic shift. A greater myopic target refraction may be warranted in eyes with a preoperative central corneal thickness of 640 mu m or greater.