Lorenzana-Blanco Natalia, Velarde-Rodríguez Gonzalo, Corte-Alonso Sofía, García-Sandoval Blanca, Jiménez-Alfaro Ignacio, Alejandre-Alba Nicolás
Ophthalmology Department, Fundación Jiménez Díaz University Hospital. Av. de los Reyes Católicos, 2. 28040, Madrid, Spain.
Ophthalmology Department, Fundación Jiménez Díaz University Hospital. Av. de los Reyes Católicos, 2. 28040, Madrid, Spain.
J Optom. 2025 Apr-Jun;18(2):100551. doi: 10.1016/j.optom.2025.100551. Epub 2025 Apr 29.
To enhance the accuracy of intraocular lens (IOL) power calculation in patients with Fuchs' endothelial corneal dystrophy (FECD) undergoing simultaneous cataract surgery and Descemet membrane endothelial keratoplasty (triple-DMEK) by predicting corneal power changes.
Observational ambispective monocentric cohort study. A linear corneal change model (LCCM) was developed to predict corneal change from the preoperative corneal ratio (anterior/posterior radius). LCCM was validated by comparing prediction errors with the traditional IOL optimization method.
97 eyes of 69 patients were analyzed. Preoperative keratometry was biometrically unmeasurable in 9 eyes, so manually entered autorefractometer data were used for IOL calculations and were analyzed separately. Mean absolute error (MAE) in the manual group (1.35 D (-1.04, 3.75)) was higher than the measured group (0.75 D (-0.62, 2.12)). The median change in simulated keratometry (SimK) was -0.21 ± 0.68 D and in total keratometry (TK) was -0.62 ± 1.09 D (p < 0.001). SRKT outperformed the rest with constant optimization (0.60 D (-0.53, 1.74)). LCCM showed similar MAE to the constant optimization method (p > 0.05). However, MAE for the optimization method was higher (2.08 D (1.77, 2.39)) than LCCM method (1.87 D (1.62, 2.12)).
SimK and TK change significantly after Triple-DMEK. The LCCM could reduce extreme refractive surprises by assisting surgeons in the individualized selection of the best IOL for each eye based on the expected corneal change. Study limitations include variability in FECD severity and the inherent limitations of biometric formulas applied to non-standard eyes. Further studies are recommended.
通过预测角膜屈光力变化，提高同时进行白内障手术和Descemet膜内皮角膜移植术（三联Descemet膜内皮角膜移植术）的Fuchs内皮角膜营养不良（FECD）患者人工晶状体（IOL）屈光力计算的准确性。
观察性双前瞻性单中心队列研究。建立线性角膜变化模型（LCCM），根据术前角膜比值（前/后半径）预测角膜变化。通过将预测误差与传统IOL优化方法进行比较，对LCCM进行验证。
分析了69例患者的97只眼。9只眼术前角膜曲率计测量无法进行生物测量，因此将自动验光仪手动输入的数据用于IOL计算并单独分析。手动组的平均绝对误差（MAE）（1.35 D（-1.04，3.75））高于测量组（0.75 D（-0.62，2.12））。模拟角膜曲率（SimK）的中位数变化为-0.21±0.68 D，总角膜曲率（TK）的中位数变化为-0.62±1.09 D（p<0.001）。在持续优化方面，简化眼屈光力计算法（SRKT）表现优于其他方法（0.60 D（-0.53，1.74））。LCCM显示出与持续优化方法相似的MAE（p>0.05）。然而，优化方法的MAE（2.08 D（1.77，2.39））高于LCCM方法（1.87 D（1.62，2.12））。
三联Descemet膜内皮角膜移植术后SimK和TK有显著变化。LCCM可以通过帮助外科医生根据预期的角膜变化为每只眼睛个体化选择最佳IOL，减少极端屈光意外情况。研究局限性包括FECD严重程度的变异性以及应用于非标准眼睛的生物测量公式的固有局限性。建议进一步研究。
