Refractive outcomes following cataract combined with lamellar keratoplasty: femtosecond-DSEK versus microkeratome-DSAEK
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ORIGINAL PAPER
Refractive outcomes following cataract combined with lamellar keratoplasty: femtosecond-DSEK versus microkeratome-DSAEK Natalya F. Shilova . Eitan Livny Boris E. Malyugin
. Natalia S. Anisimova . Olga P. Antonova .
Received: 7 July 2020 / Accepted: 5 October 2020 Ó Springer Nature B.V. 2020
Abstract Purpose Prediction of postoperative refraction following posterior lamellar keratoplasty is crucial for choosing proper intraocular lens power in combined surgeries. Femtosecond laser-assisted Descemet stripping endothelial keratoplasty (FS-DSEK) creates thin, planar grafts while microkeratome-assisted Descemet’s stripping automated endothelial keratoplasty (DSAEK) creates non-planar, concaved grafts. We evaluated whether this fundamental difference affects the refractive outcomes in cataract surgery combined with FS-DSEK compared to cataract surgery combined with microkeratome-assisted DSAEK. Methods A retrospective analysis of 28 patients who underwent FS-DSEK combined with phacoemulsification and intraocular lens (IOL) implantation (group
Natalya F. Shilova and Eitan Livny have Contributed equally to this work. N. F. Shilova N. S. Anisimova O. P. Antonova B. E. Malyugin S. Fyodorov Eye Microsurgery State Institution, Moscow, Russia E. Livny (&) Department of Ophthalmology, Rabin Medical Center, Petach Tikva, Israel e-mail: [email protected] E. Livny Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
A) compared to 26 patients who underwent microkeratome-assisted DSAEK combined with phacoemulsification and IOL implantation (group B). Pre- and 1-year postoperative best-corrected visual acuity (BCVA), keratometry values, corneal thickness, central-to-peripheral graft thickness ratio (C/P ratio), and target postoperative spherical equivalent (SE) versus actual postoperative SE were analyzed. Results Target postoperative SE and actual postoperative SE significantly shifted toward hyperopia in group B, but not in group A. Postoperative hyperopic shifts were 0.14 D and 1.13 D in groups A and B, respectively (P \ 0.001). BCVA improved after surgery in both groups, with no significant difference between the groups. Postoperative C/P ratio differed significantly between the groups and was negatively correlated with postoperative hyperopic shift (r = - 0.616, P \ 0.001). Conclusion Refractive outcomes of cataract surgery combined with FS-DSEK are relatively neutral, whereas those of cataract surgery combined with microkeratome-assisted DSAEK cause significant hyperopic shift. Clinicians should select accordingly an appropriate intraocular lens power when performing these surgeries. Keywords Descemet stripping endothelial keratoplasty Phacoemulsification Cataract Intraocular lens Femtosecond DSEK
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Int Ophthalmol
Introduction In the past two decades, endothelial keratoplasty has gained popularity among surgeons as an alternative to penetrating keratoplasty for the treatment for corneal endothelial dysfunction [1–3]. Patient
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