Department of Anterior Segment and Refractive Surgery, Adolphe de Rothschild Foundation Hospital, Paris, France.
Cornea. 2023 Aug 1;42(8):954-961. doi: 10.1097/ICO.0000000000003100. Epub 2022 Sep 23.
The aim of this study was to determine the mechanisms leading to the refractive shift and intraocular lens calculation error induced by Descemet membrane endothelial keratoplasty (DMEK), using ocular biometry and corneal elevation tomography data.
This is a retrospective, monocentric cohort study. Eyes which underwent uncomplicated DMEK surgery with available pre-DMEK and post-DMEK Scheimpflug rotating camera data (Pentacam, Oculus, Wetzlar, Germany) were considered for inclusion with an age-matched control group of healthy corneas. Cataract surgery data were collected for triple-DMEK cases. DMEK-induced refractive shift (DIRS) and intraocular lens calculation error (DICE) were calculated. Pearson r correlation coefficient was calculated between each corneal parameter variation and both DIRS and DICE.
DIRS was calculable for 49 eyes from 43 patients. It was 30.61% neutral, 53.06% hyperopic (36.73% > 1D), and 16.32% myopic (6.12% > 1 D). DICE was calculable for 30 eyes of 26 patients: It was 46.67% neutral, 40.00% hyperopic (10.00% > 1D), and 13.33% myopic (3.33% > 1D). DIRS and DICE were mainly associated with variations in PRC/ARC ratio, anterior average radii of curvature (ARC), posterior average radii of curvature (PRC), and posterior Q.
Our results suggest that ARC variations, PRC/ARC ratio variations, PRC variations, and posterior Q variations are the most influential parameters for both DIRS and DICE. We suggest that a distinction between those different phenomenons, both currently described as "hyperopic shift" in the literature, should be made by researchers and clinicians.
本研究旨在通过眼生物测量和角膜高程断层扫描数据，确定导致 Descemet 膜内皮角膜移植术（DMEK）引起的屈光漂移和人工晶状体计算误差的机制。
这是一项回顾性、单中心队列研究。纳入了接受单纯 DMEK 手术且有术前和术后 Scheimpflug 旋转相机数据（Pentacam，Oculus，德国威茨拉尔）的眼，并与年龄匹配的健康角膜对照组进行比较。对三焦点 DMEK 病例收集了白内障手术数据。计算 DMEK 诱导的屈光漂移（DIRS）和人工晶状体计算误差（DICE）。计算了每个角膜参数变化与 DIRS 和 DICE 之间的 Pearson r 相关系数。
可计算 DIRS 的有 43 例 49 只眼。其中 30.61%为中性，53.06%为远视（36.73% > 1D），16.32%为近视（6.12% > 1D）。可计算 DICE 的有 26 例 30 只眼：其中 46.67%为中性，40.00%为远视（10.00% > 1D），13.33%为近视（3.33% > 1D）。DIRS 和 DICE 主要与 PRC/ARC 比、前平均曲率半径（ARC）、后平均曲率半径（PRC）和后 Q 的变化有关。
我们的结果表明，ARC 变化、PRC/ARC 比变化、PRC 变化和后 Q 变化是 DIRS 和 DICE 的最主要影响因素。我们建议研究人员和临床医生应将目前文献中描述为“远视漂移”的这些不同现象进行区分。
