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Graefe's Archive for Clinical and Experimental Ophthalmology
Published in: Graefe's Archive for Clinical and Experimental Ophthalmology 4/2021

Open Access 01-04-2021 | Keratoplasty | Refractive Surgery

Assessing the validity of corneal power estimation using conventional keratometry for intraocular lens power calculation in eyes with Fuch’s dystrophy undergoing Descemet membrane endothelial keratoplasty

Authors: Raphael Diener, Maximilian Treder, Jost Lennart Lauermann, Nicole Eter, Maged Alnawaiseh

Published in: Graefe's Archive for Clinical and Experimental Ophthalmology | Issue 4/2021

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Abstract

Purpose

The present retrospective study was designed to test the hypothesis that the postoperative posterior to preoperative anterior corneal curvature radii (PPPA) ratio in eyes with Fuch’s dystrophy undergoing Descemet membrane endothelial keratoplasty (DMEK) is significantly different to the posterior to anterior corneal curvature radii (PA) ratio in virgin eyes and therefore renders conventional keratometry (K) and the corneal power derived by it invalid for intraocular lens (IOL) power calculation.

Methods

Measurement of corneal parameters was performed using Scheimpflug imaging (Pentacam HR, Oculus, Germany). In 125 eyes with Fuch’s dystrophy undergoing DMEK, a fictitious keratometer index was calculated based on the PPPA ratio. The preoperative and postoperative keratometer indices and PA ratios were also determined. Results were compared to those obtained in a control group consisting of 125 eyes without corneal pathologies. Calculated mean ratios and keratometer indices were then used to convert the anterior corneal radius in each eye before DMEK to postoperative posterior and total corneal power. To assess the most appropriate ratio and keratometer index, predicted and measured powers were compared using Bland-Altman plots.

Results

The PPPA ratio determined in eyes with Fuch’s dystrophy undergoing DMEK was significantly different (P < 0.001) to the PA ratio in eyes without corneal pathologies. Using the mean PA ratio (0.822) and keratometer index (1.3283), calculated with the control group data to convert the anterior corneal radius before DMEK to power, leads to a significant (P < 0.001) underestimation of postoperative posterior negative corneal power (mean difference (∆ = − 0.14D ± 0.30) and overestimation of total corneal power (∆ = − 0.45D ± 1.08). The lowest prediction errors were found using the geometric mean PPPA ratio (0.806) and corresponding keratometer index (1.3273) to predict the postoperative posterior (∆ = − 0.01 ± 0.30) and total corneal powers (∆ = − 0.32D ± 1.08).

Conclusions

Corneal power estimation using conventional K for IOL power calculation is invalid in eyes with Fuch’s dystrophy undergoing DMEK. To avoid an overestimation of corneal power and minimize the risk of a postoperative hyperopic shift, conventional K for IOL power calculation should be adjusted in eyes with Fuch’s dystrophy undergoing cataract surgery combined with DMEK. The fictitious PPPA ratio and keratometer index may guide further IOL power calculation methods to achieve this.
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Metadata
Title
Assessing the validity of corneal power estimation using conventional keratometry for intraocular lens power calculation in eyes with Fuch’s dystrophy undergoing Descemet membrane endothelial keratoplasty
Authors
Raphael Diener
Maximilian Treder
Jost Lennart Lauermann
Nicole Eter
Maged Alnawaiseh
Publication date
01-04-2021
Publisher
Springer Berlin Heidelberg
Keyword
Keratoplasty
Published in
Graefe's Archive for Clinical and Experimental Ophthalmology / Issue 4/2021
Print ISSN: 0721-832X
Electronic ISSN: 1435-702X
DOI
https://doi.org/10.1007/s00417-020-04998-w

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