Netherlands Institute for Innovative Ocular Surgery, Rotterdam, The Netherlands.
J Cataract Refract Surg. 2011 Aug;37(8):1455-64. doi: 10.1016/j.jcrs.2011.02.033.
To determine the refractive change and stability of the transplanted cornea after Descemet membrane endothelial keratoplasty (DMEK) through a 3.0 mm clear corneal incision.
Tertiary referral center.
Cohort study.
Subjective and objective refractive data from pseudophakic eyes were obtained before and 3 and 6 months after DMEK.
The study comprised 50 eyes, 7 were phakic and 43 pseudophakic. Six months postoperatively, the corrected distance visual acuity was 20/25 (0.8) or better in 38 eyes (74%). The mean increase in spherical equivalent at 6 months (N = 50) was +0.32 diopter (D) ± 1.01 D (SD) (P=.0304) and in refractive cylinder, -0.48 ± 1.02 D (P=.001). Although Scheimpflug imaging showed a stable anterior corneal curvature, the posterior curvature increased from 5.50 ± 0.5 D preoperatively to 6.40 ± 0.4 D at 6 months and pachymetry decreased from 672 ± 82 μm to 540 ± 59 μm, respectively (both N = 32) (both P=.000).
After DMEK, a slight preoperative to postoperative refractive change and stabilization at 3 months occurred that may induce a hyperopic shift that was not the result of the negative lenticule effect of DSEK/DSAEK. Thus, in DMEK, the hyperopic shift may result from a reversal of a preceding myopic shift induced by stromal swelling in endothelial disease. If so, normal intraocular power nomograms apply for cataract surgery before or during DMEK.
通过 3.0mm 透明角膜切口确定 Descemet 膜内皮角膜移植（DMEK）后移植角膜的屈光变化和稳定性。
三级转诊中心。
队列研究。
对行 DMEK 术后的白内障眼术前和术后 3、6 个月的主观和客观屈光数据进行测量。
本研究共纳入 50 只眼，其中 7 只为正视眼，43 只为白内障术后眼。术后 6 个月时，38 只眼（74%）矫正视力达到 20/25（0.8）或更好。50 只眼在 6 个月时平均等效球镜增加量为+0.32 屈光度（D）±1.01 D（标准差）（P=.0304），屈光柱减少-0.48±1.02 D（P=.001）。虽然 Scheimpflug 成像显示前角膜曲率稳定，但后角膜曲率从术前的 5.50±0.5 D 增加到术后 6 个月的 6.40±0.4 D，角膜厚度从 672±82μm 减少到 540±59μm（均 N = 32）（均 P=.000）。
DMEK 术后 3 个月时，屈光状态发生了轻微的术前到术后变化并稳定下来，这可能导致远视漂移，而不是 DSEK/DSAEK 的负晶状体效应的结果。因此，在 DMEK 中，远视漂移可能是由内皮疾病引起的基质肿胀引起的先前近视漂移的逆转引起的。如果是这样，那么在 DMEK 之前或期间进行白内障手术时，应使用正常的眼内屈光力正常值图表。
