Purpose

: To compare changes in corneal power measurements after Descemet membrane endothelial keratoplasty (DMEK) vs. ultrathin Descemet stripping automated endothelial keratoplasty (UT-DSAEK).

Setting

: Hospital centers

Design

: Post-hoc sub-analysis of the randomized controlled DETECT Trial

Methods

: 50 eyes (38 patients) with endothelial dysfunction from Fuchs’ endothelial dystrophy or pseudophakic bullous keratopathy were randomized to DMEK or UT-DSAEK 1 to 2 days prior to surgery. Total Corneal Refractive Power (TCRP) and anterior/posterior simulated keratometry were obtained using Scheimpflug imaging preoperatively (baseline) and postoperatively at 3, 6, 12, and 24 months. Spectacle refractions were performed at 6, 12, and 24 months after surgery.

Results

: Mean hyperopic shift of TCRP from baseline to 12 months was 0.80±1.1 (p=0.002) in the DMEK group and 0.69±0.84 (p<0.001) in the UT-DSAEK group. Posterior corneal curvature (Km) steepened (more negative dioptric power) by 0.42±0.10 (p<0.001) in DMEK and 0.54±0.09 (p<0.001) in UT-DSAEK. Mean change in TCRP and posterior corneal curvature did not differ between DMEK and UT-DSAEK (TCRP, p=0.71; posterior Km, p=0.36).

Conclusions

: Sustained steepening in posterior corneal curvature with loss in total corneal power contributes to hyperopic shifts after endothelial keratoplasty. Changes in corneal measurements do not differ between DMEK and UT-DSAEK.

中文翻译：

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内皮角膜移植术后长达两年的角膜屈光度变化：随机对照检测试验的结果

目的

: 比较后弹力层内皮角膜移植术 (DMEK) 与超薄后弹力层剥离自动内皮角膜移植术 (UT-DSAEK) 后角膜屈光力测量值的变化。

环境

: 医院中心

设计

：随机对照检测试验的事后子分析

方法

：50 只眼（38 名患者）因 Fuchs 内皮营养不良或假性晶状体大疱性角膜病变而导致内皮功能障碍，在手术前 1 至 2 天随机接受 DMEK 或 UT-DSAEK。在术前（基线）和术后 3、6、12 和 24 个月时使用 Scheimpflug 成像获得总角膜屈光力 (TCRP) 和前/后模拟角膜曲率测量法。在手术后 6、12 和 24 个月进行眼镜屈光检查。

结果

：TCRP 从基线到 12 个月的平均远视偏移在 DMEK 组中为 0.80±1.1 (p=0.002)，在 UT-DSAEK 组中为 0.69±0.84 (p<0.001)。在 DMEK 中，角膜后曲率 (Km) 变陡（负屈光力更大）0.42±0.10 (p<0.001)，在 UT-DSAEK 中变陡 0.54±0.09 (p<0.001)。TCRP 和后角膜曲率的平均变化在 DMEK 和 UT-DSAEK 之间没有差异（TCRP，p=0.71；后 Km，p=0.36）。

结论

：角膜后曲率的持续变陡以及总角膜屈光力的丧失导致内皮角膜移植术后的远视偏移。DMEK 和 UT-DSAEK 之间角膜测量值的变化没有差异。