J Refract Surg. 2020 Oct 1;36(10):661-666. doi: 10.3928/1081597X-20200729-02.
To evaluate the refractive outcomes of Descemet membrane endothelial keratoplasty combined with cataract surgery (DMEK triple) in patients with Fuchs endothelial dystrophy.
A retrospective analysis of 68 eyes of 68 patients with Fuchs endothelial dystrophy who underwent DMEK triple between 2014 and 2018.
The mean age of patients was 66.5 ± 8.6 years, and 65% (44 of 68) were female. Mean target refraction was -0.69 diopters (D) (interquartile range: -0.80 to -0.50 D). At 6 months, 47% (32 of 68) and 63% (43 of 68) of eyes were within ±0.50 and ±1.00 D of target refraction, respectively. Among eyes greater than 0.50 D from target, 78% (28 of 36) were hyperopic surprises. Mean spherical equivalent at 6 months was -0.14 ± 1.26 D, representing a mean hyperopic shift of 0.55 D from target. Preoperative pachymetry was higher in eyes with greater than 0.50 D of hyperopic surprise (648 ± 60 vs 613 ± 49 µm, P = .04). Refractive shift was greater in eyes with a preoperative central corneal thickness of 640 µm or greater versus eyes with a central corneal thickness of less than 640 µm (+1.20 ± 0.92 vs +0.40 ± 0.99 D, P = .02). None of the eyes with a preoperative central corneal thickness of 640 µm or greater shifted myopically compared to target (range: -0.09 to +2.89 D).
A mean hyperopic shift of 0.55 D from target refraction occurred after DMEK triple, and 47% of eyes were within 0.50 D of target refraction at 6 months postoperatively. Thicker corneas preoperatively had greater hyperopic shift. A greater myopic target refraction may be warranted in eyes with a preoperative central corneal thickness of 640 µm or greater. [J Refract Surg. 2020;36(10):661-666.].
评估 2014 年至 2018 年间行 Descemet 膜内皮角膜移植联合白内障手术（DMEK 三联术）的 Fuchs 内皮营养不良患者的屈光结果。
对 68 例 68 只眼 Fuchs 内皮营养不良患者行 DMEK 三联术的回顾性分析。
患者平均年龄为 66.5 ± 8.6 岁，65%（44/68）为女性。平均目标屈光度为-0.69 屈光度（D）（四分位距：-0.80 至-0.50 D）。术后 6 个月，47%（32/68）和 63%（43/68）的眼分别在目标屈光度的±0.50 和±1.00 D 范围内。在距离目标屈光度大于 0.50 D 的眼，78%（28/36）为远视性超矫。术后 6 个月平均等效球镜为-0.14 ± 1.26 D，提示目标值平均远视漂移 0.55 D。远视性超矫大于 0.50 D 的眼术前角膜中央厚度更高（648 ± 60 比 613 ± 49 µm，P =.04）。术前中央角膜厚度为 640 µm 或更大的眼比中央角膜厚度小于 640 µm 的眼的屈光漂移更大（+1.20 ± 0.92 比+0.40 ± 0.99 D，P =.02）。术前中央角膜厚度为 640 µm 或更大的眼与目标值相比，无一例发生近视漂移（范围：-0.09 至+2.89 D）。
DMEK 三联术后，目标屈光度平均远视漂移 0.55 D，术后 6 个月 47%的眼屈光度在目标值的 0.50 D 以内。术前角膜更厚的眼远视漂移更大。对于术前中央角膜厚度为 640 µm 或更大的眼，可能需要更大的近视目标屈光度。[J Refract Surg. 2020;36(10):661-666.]。
