Refractive Change After Descemet Stripping Automated Endothelial Keratoplasty Surgery and Its Correlation With Graft Thickness and Diameter

Purpose: The purpose of this study was to evaluate the refractive change after Descemet stripping automated endothelial keratoplasty (DSAEK) surgery and its correlation with graft thickness and diameter. Methods: We retrospectively analyzed the refractive outcomes of 45 cases of DSAEK surgery that were performed at Duke University Eye Center between August 2005 and December 2006. We divided our study groups into DSAEK triple cases and pseudophakic DSAEK cases. We measured manifest refraction preoperatively and postoperatively in each group and compared the difference between the preoperative and the postoperative spherical equivalent. We evaluated the correlation of the refractive change with graft thickness and diameter. Results: Forty-five DSAEK cases in 44 patients (27 women and 17 men) were evaluated and analyzed. Mean age of the patients at surgery was 67.6 years (15-81 years, SD 10.7 years). Forty cases were treated for Fuchs endothelial dystrophy and 5 for pseudophakic bullous keratopathy/bullous keratopathy. Seventeen cases were DSAEK triple cases and 28 pseudophakic DSAEK cases. In the DSAEK triple group, the mean change in refraction at an average of 4 months postoperatively was +1.15 D (range −0.02 to 2.87, SD 1.15). In the pseudophakic DSAEK group, the mean change in refraction at an average of 5 months postoperatively was +0.71 D (range −1.75 to 3.0, SD 1.11). The overall refractive change was +0.88 D (range −1.75 to 3.0, SD 1.02). Correlation of refractive change with graft diameter was modest (r = 0.29, P = 0.05), and a small correlation was found with respect to graft thickness (r = −0.16, P = 0.31). Conclusions: Our study of DSAEK grafts demonstrated a hyperopic refractive shift after DSAEK surgery. This observation should be taken into consideration when deciding on the appropriate intraocular lens power in DSAEK triple surgery and may also aid in anticipating refractive outcomes after pseudophakic DSAEK surgery. Further studies to follow these refractive changes over a longer follow-up period and to investigate the mechanism of this refractive change after DSAEK surgery are warranted.