Wills Eye Conference
Wills Eye Conference
Perspective from Christopher J. Rapuano , MD
March 09, 2015
1 min read

Graft thickness has little effect on refractive shift after DSEK, phaco

Perspective from Christopher J. Rapuano , MD
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PHILADELPHIA — Central graft thickness and postoperative refractive shift showed a weak correlation 3 months after Descemet’s stripping endothelial keratoplasty in pseudophakic eyes, according to a study presented here.

P. Lesniak

“If someone is planning a triple procedure or a combined cataract extraction with DSEK, and when you’re performing your IOL calculations and when you’re choosing the lens, you want to know what your refractive outcome will be, and that will guide your lens selection,” Sebastian P. Lesniak, MD, said at the Wills Eye Alumni Conference.

“The key assumption here in the triple procedures, or DSEK combined with cataract extraction, is that we didn’t use the preop refraction. We used the refractive aim, and we looked at the Holladay 1 IOL calculation,” Lesniak said.

The retrospective study included 257 patients who underwent DSEK between 2010 and 2014.

Inclusion criteria included use of pre-cut tissue with central graft thickness reported by the eye bank. Patients underwent pseudophakic DSEK or DSEK combined with cataract surgery.

Patients with multiple DSEK grafts, DSEK under previous penetrating keratoplasty, history of retinal surgery, anterior vitrectomy during DSEK, IOL exchange, secondary IOL or poor visual acuity were excluded.

Twenty-seven eyes of 24 patients met the inclusion criteria. Fourteen eyes underwent DSEK alone, and 13 underwent DSEK combined with cataract surgery.

All eyes underwent refraction 3 months after surgery.

Average postoperative visual acuity was 20/32 (range: 20/20 to 20/50).

The average refractive shift was 0.68 D in pseudophakic eyes and 0.94 D in eyes that underwent combined DSEK and cataract surgery.

Average graft thickness 104 µm.

“In conclusion, our average observed refractive shift is hyperopic, as previously published in numerous papers, and it is consistent with the previously published magnitude, anywhere from 0.7 D to just over a diopter. Based on our limited data set, there’s little correlation between central graft thickness and the postoperative refractive shift,” Lesniak said. – by Matt Hasson

Disclosure: Lesniak reports no relevant financial disclosures.