Tomographic changes in eyes with hyperopic shift after triple Descemet membrane endothelial keratoplasty

To describe the tomographic changes in eyes with a hyperopic shift after triple Descemet membrane endothelial keratoplasty (DMEK).

Private cornea practice, Blue Ash, Ohio, USA.

Retrospective case series.

Patients who had previous triple DMEK with preoperative and postoperative Scheimpflug corneal tomography (Pentacam) measurements and corresponding manifest refraction measurements were reviewed. Eyes with and without a hyperopic postoperative shift were compared at either the 1-month or 3- to 6-month follow-ups. Assessed parameters included demographics, cataract testing, visual acuity, manifest refraction, and Scheimpflug tomography data.

Sixty-two eyes of 47 patients (21 men, 26 women) with Fuchs endothelial corneal dystrophy were included. Preoperative posterior flat keratometry (K), posterior steep K, posterior average K, central pachymetry, and asphericity (Q value) of the posterior cornea were significantly different when comparing the hyperopic and non-hyperopic group. At the postoperative 1-month and 3- to 6-month follow-ups, there was a significant between-group difference in change in postoperative anterior K (average), posterior K (average), central pachymetry, and posterior Q values compared with preoperative values. The combined preoperative criteria of posterior flat K (≥-5.25), central pachymetry (≥670 μm), and posterior Q value (≥0.5) had a sensitivity of 58% (11/19 correctly identified hyperopic shifts) and specificity of 81% (8/43 incorrectly identified).

Eyes with a hyperopic surprise after triple DMEK demonstrated a significant change in posterior and anterior corneal curvature compared with eyes without a hyperopic surprise. This might be secondary to corneal edema because these eyes also demonstrated greater preoperative corneal pachymetry.