van Dijk Korine, Rodriguez-Calvo-de-Mora Marina, van Esch Hilde, Frank Laurence, Dapena Isabel, Baydoun Lamis, Oellerich Silke, Melles Gerrit R J
*Netherlands Institute for Innovative Ocular Surgery, Rotterdam, the Netherlands;†Melles Cornea Clinic Rotterdam, Rotterdam, the Netherlands;‡Hospital Regional Universitario Málaga, Spain; and§Amnitrans EyeBank Rotterdam, Rotterdam, the Netherlands.
Cornea. 2016 Dec;35(12):1548-1555. doi: 10.1097/ICO.0000000000001022.
To monitor refractive changes after Descemet membrane endothelial keratoplasty (DMEK) and to determine what may influence these changes and the time point of stabilization.
From 67 pseudophakic DMEK eyes operated on for Fuchs endothelial dystrophy at a tertiary referral center, biomicroscopy, visual acuity, subjective refraction, and Scheimpflug-based corneal tomography data were obtained before and up to 2 years postoperatively. Visual acuity and changes in spherical equivalent (SE), mean anterior and posterior simulated keratometry (Km), and central pachymetry were analyzed.
At 3 months postoperatively, both hyperopic (28/67 eyes) and myopic (21/67 eyes) shifts were observed; 18/67 eyes showed no SE change. The mean change in SE at 3 months was +0.33 diopters (D) (95% confidence interval = [0.11, 0.54], P = 0.028), which stabilized thereafter (P > 0.466). Initial flattening of mean anterior Km by 0.66D (95% confidence interval = [-0.81, -0.51], P < 0.001) at 3 months was followed by a slow steepening, which became significant between 1 and 2 years postoperatively (P < 0.001). Posterior Km stabilized after 3 months (P > 0.252). Preoperative to 3 months postoperative absolute changes in anterior Km were positively related to preoperative backscattered light from the central anterior cornea (P = 0.035), and the presence of partial graft detachment postoperatively (P = 0.013).
After DMEK, SE and posterior corneal curvature were on average stable at 3 months after surgery, whereas the mean anterior corneal curvature showed an ongoing gradual change. Changes in anterior corneal curvature may be related to preoperative anterior corneal densitometry or postoperative partial graft detachment.
监测Descemet膜内皮角膜移植术（DMEK）后的屈光变化，并确定哪些因素可能影响这些变化以及稳定的时间点。
在一家三级转诊中心，对67只因Fuchs内皮营养不良接受手术的人工晶状体眼行DMEK，在术前及术后长达2年的时间里，获取生物显微镜检查、视力、主观验光以及基于Scheimpflug的角膜断层扫描数据。分析视力以及等效球镜度（SE）、模拟前后平均角膜曲率（Km）和中央角膜厚度的变化。
术后3个月，观察到既有远视性移位（28/67眼）也有近视性移位（21/67眼）；18/67眼的SE无变化。3个月时SE的平均变化为+0.33屈光度（D）（95%置信区间=[0.11, 0.54]，P = 0.028），此后趋于稳定（P > 0.466）。3个月时平均前Km最初平坦了0.66D（95%置信区间=[-0.81, -0.51]，P < 0.001），随后缓慢变陡，在术后1至2年变得显著（P < 0.001）。后Km在3个月后稳定（P > 0.
