Vision Engineering, Rome, Italy.
Graefes Arch Clin Exp Ophthalmol. 2010 Mar;248(3):421-7. doi: 10.1007/s00417-009-1284-2. Epub 2010 Jan 29.
Although Descemet stripping automated endothelial keratoplasty (DSAEK) was demonstrated to be effective for the treatment of endothelial corneal diseases, a variable hyperopic shift has been measured as a common occurrence postoperatively. The aim of this work was to investigate the variance in the corneal and refractive responses to DSAEK combined with phacoemulsification and implantation of intra-ocular lens (IOL), namely the DSAEK triple procedure.
The refractive, topographic, and anterior segment optical coherence tomography (AS-OCT) data of 23 eyes treated with DSAEK triple procedure were analyzed. A mean refractive IOL target of -1.04 +/- 0.09 D was calculated based on empirical data of our early experience to achieve emmetropia in all the eyes included in the study. Donor corneal parameters, i.e., graft diameter, thickness, and profile, were investigated in order to verify their possible role in the variable refractive shift after DSAEK.
Although the 1-year mean refractive outcome was close to emmetropia (-0.01 +/- 0.89 D), the average difference between the targeted postoperative refraction and the 1-year postoperative spherical equivalent refraction was +0.98 +/- 0.87 D. Correlations of refractive change with central graft thickness (r = 0.36, p = 0.05) and graft diameter (r = 0.45; p = 0.03) were statistically significant. AS-OCT analysis revealed how the graft shape, with graft thicker in the periphery compared with the center, contributed to reduce the radius of curvature of the posterior cornea, thus favoring the hyperopic shift postoperatively.
DSAEK triple procedure provides negligible changes in the surface topography, however with a variable amount of hyperopic shift postoperatively. Central graft thickness and graft profile together contributed to approximately two-thirds of the variance in refractive shift postoperatively. Lenticule diameter provided a minor influence on postoperative hyperopic shift than other graft parameters.
虽然撕囊的自动化内皮角膜移植术（DSAEK）已被证实对治疗内皮角膜疾病有效，但术后常出现可测量的远视漂移。本研究旨在调查白内障超声乳化联合人工晶状体（IOL）植入联合 DSAEK（即 DSAEK 三联手术）后的角膜和屈光反应的差异。
对 23 只接受 DSAEK 三联手术的眼的屈光、地形图和眼前节光学相干断层扫描（AS-OCT）数据进行分析。根据我们早期经验的经验数据，计算平均 IOL 目标屈光度为-1.04 +/- 0.09 D，以实现所有研究眼的正视化。研究供体角膜参数，即移植物直径、厚度和形态，以验证其在 DSAEK 后屈光变化中的可能作用。
尽管 1 年平均屈光结果接近正视（-0.01 +/- 0.89 D），但目标术后屈光与 1 年术后等效球镜屈光的平均差值为+0.98 +/- 0.87 D。屈光变化与中央移植物厚度（r = 0.36，p = 0.05）和移植物直径（r = 0.45；p = 0.03）呈正相关。AS-OCT 分析显示，与中心相比，移植物周边较厚的移植物形状如何有助于降低后角膜曲率半径，从而有利于术后远视漂移。
DSAEK 三联手术对表面形貌的变化可忽略不计，但术后会出现一定程度的远视漂移。中央移植物厚度和移植物形态共同导致术后屈光变化的约三分之二。与其他移植物参数相比，透镜直径对术后远视漂移的影响较小。
