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Optimizing IOL calculation in triple-DMEK: Data from a real-life cohort.

Natalia Lorenzana-Blanco1, Gonzalo Velarde-Rodríguez1, Sofía Corte-Alonso1

  • 1Ophthalmology Department, Fundación Jiménez Díaz University Hospital. Av. de los Reyes Católicos, 2. 28040, Madrid, Spain.

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|April 30, 2025
PubMed
Summary
This summary is machine-generated.

Predicting corneal power changes after triple-DMEK surgery can improve intraocular lens (IOL) calculations. A new linear corneal change model (LCCM) shows promise in reducing refractive errors for patients with Fuchs

Keywords:
Fuchs’ endothelial corneal dystrophyIol constant optimizationIol power calculation formulasTriple-dmekhyperopic shift

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Area of Science:

  • Ophthalmology
  • Corneal Surgery
  • Refractive Surgery

Background:

  • Fuchs' endothelial corneal dystrophy (FECD) presents challenges for intraocular lens (IOL) power calculation during combined cataract surgery and Descemet membrane endothelial keratoplasty (triple-DMEK).
  • Accurate IOL power calculation is crucial for achieving desired refractive outcomes after triple-DMEK.
  • Predicting post-operative corneal power changes is essential for optimizing IOL selection.

Purpose of the Study:

  • To enhance the accuracy of IOL power calculation in triple-DMEK by predicting post-operative corneal power changes.
  • To develop and validate a novel model for predicting corneal changes after triple-DMEK.
  • To compare the predictive accuracy of the new model with traditional IOL optimization methods.

Main Methods:

  • An observational ambispective monocentric cohort study was conducted.
  • A linear corneal change model (LCCM) was developed using the preoperative corneal ratio (anterior/posterior radius) to predict corneal power changes.
  • LCCM prediction errors were compared against a traditional IOL optimization method for validation.

Main Results:

  • The study analyzed 97 eyes from 69 patients undergoing triple-DMEK.
  • Significant median changes in simulated keratometry (SimK) of -0.21 D and total keratometry (TK) of -0.62 D were observed post-surgery (p < 0.001).
  • The LCCM demonstrated comparable mean absolute error (MAE) to the constant optimization method but showed a lower MAE (1.87 D) compared to the optimization method (2.08 D).

Conclusions:

  • Corneal power (SimK and TK) significantly changes after triple-DMEK.
  • The LCCM aids surgeons in selecting the appropriate IOL by predicting corneal changes, potentially reducing refractive surprises.
  • Further research is recommended due to FECD severity variability and limitations of standard biometric formulas in non-standard eyes.