Corneal profile analysis after Descemet stripping endothelial keratoplasty and its relationship to postoperative hyperopic shift

Purpose

To evaluate changes in the corneal profile after Descemet stripping endothelial keratoplasty (DSEK) using anterior segment optical coherence tomography (AS-OCT) analysis and to describe its relationship to a dynamic postoperative hyperopic shift.

Setting

John A. Moran Eye Center, University of Utah, Salt Lake City, USA.

Methods

In this retrospective observational study, 9 eyes had DSEK and were followed with manifest refractions and AS-OCT analysis. To assess changes in the thickness of the cornea, measurements for each AS-OCT image were taken at the vertex of the cornea, at 1.5 mm on each side of the vertex, and at the distal edges of the graft.

Results

Patients were followed for a mean of 134 days (range 46 to 228 days). Monthly Graft thinning rates were 5.2 μm per month at the vertex, 7.9 μm per month 1.5 mm from the vertex, and 26 μm per month at the edges, with the edges thinning significantly faster than the cornea vertex (P = .0024) and the points on either side of the 3.0 mm visual axis (P = .0018). The mean spherical equivalent (SE) showed an initial hyperopic shift that decreased over the ensuing 100 to 200 days postoperatively. The mean monthly postoperative SE change was −0.25 diopter (D) with a mean preoperative to postoperative SE change of +1.26 D.

Conclusions

The donor graft underwent changes after DSEK, which may account for the induced hyperopia and its diminishment over time via changes in the posterior corneal curvature. Results suggest that intraocular lenses be targeted to −1.00 to −1.25 D of myopia for combined DSEK and cataract procedures.