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Prepare for hyperopic shift following DSAEK graft surgery


A retrospective study including 45 eyes that underwent Descemet's stripping automated endothelial keratoplasty (DSAEK) found an average refractive change of +0.88 D after surgery. That hyperopic shift after DSAEK has implications for management of patients undergoing cataract surgery simultaneously with or after DSAEK and for anticipating refractive outcomes in pseudophakic patients undergoing DSAEK.

Durham, NC-Results of a retrospective study evaluating refractive change after Descemet’s stripping automated endothelial keratoplasty (DSAEK) surgery show a hyperopic shift, said Bokkwan Jun, MD, PhD.

"Further studies are warranted to evaluate the refractive change after longer follow-up and to understand its mechanism," said Dr. Jun, research associate, Duke University Eye Center, Durham, NC.

"However, based on our observations, we recommend considering adjusting the IOL power in patients undergoing a DSAEK triple procedure (DSAEK, phacoemulsification, IOL implantation) and in DSAEK patients undergoing cataract surgery," he said.

"This information may also aid in anticipating refractive outcomes after pseudophakic DSAEK surgery," he said.

Dr. Jun and colleagues conducted a retrospective review of all cases of DSAEK surgery performed by three surgeons at the Duke University Eye Center between August 2005 and December 2006, to investigate the occurrence of a postoperative refractive change and any correlations with graft thickness and diameter. Eyes were excluded from the study if any DSAEK complications developed, such as graft failure or rejection, or if they had a noncorneal condition that would affect visual acuity, such as glaucoma or retinal pathology.

Data were analyzed for a total of 45 cases of 44 patients who had at least 3 months follow-up after DSAEK as well as spherical equivalent data available from a manifest refraction performed preoperatively and at last follow-up. Fuchs’ endothelial dystrophy was the underlying diagnosis in the majority of eyes (89%), and the remaining cases were treated with DSAEK for pseudophakic bullous keratopathy/bullous keratopathy. Almost two-thirds of eyes were pseudophakic at the time of DSAEK (28 eyes, 62%) and the rest (17 eyes, 38%) underwent DSAEK triple surgery. The average age of patients in the study was 68 years (range, 15 to 81 years).

The overall refractive change in the 45 eyes was +0.88 D. After subgroup classification, the mean refractive change was +1.15 D in 17 eyes that underwent DSAEK triple surgery and +0.71 D in 28 pseudophakic DSAEK eyes. The difference between the two groups was not statistically significant.

Read the complete article in the Oct. 1, 2008 issue of Ophthalmology Times.

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