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John P Berdahl M.D.* David R. Hardten M.D. , F.A.C.S.*

Topographic and Axial Length Changes after Descemet’s Stripping Endothelial Keratoplasty:  The effect on refractive error. John P Berdahl M.D.* David R. Hardten M.D. , F.A.C.S.*. *No relevant financial disclosures. Background.

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John P Berdahl M.D.* David R. Hardten M.D. , F.A.C.S.*

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  1. Topographic and Axial Length Changes after Descemet’s Stripping Endothelial Keratoplasty:  The effect on refractive error John P Berdahl M.D.* David R. Hardten M.D. , F.A.C.S.* *No relevant financial disclosures

  2. Background • Descemet’s Stripping Endothelial Keratoplasty (DSEK) is known to cause a hyperopic shift. • The hyperopic shift has been attributed to the divergent refractive property of the DSEK lenticule itself. • Other factors such as keratometry and axial length could also contribute. Purpose • To evaluate if keratometry changes are caused by DSEK and if changes correlate with induced refractive error

  3. Methods • Comparisons Comparison to contralateral eye • Keratomety (Manual or Topo) • Pachymetry • Axial length (if present) Comparison of DSEK eye (pre and post-op) • Change in Keratomety • Change in Pachymetry • Change in Visual acuity • Change in refraction from prediction* *Predicted post-op refraction was based on IOL calculations in patients with combined cataract surgery. *Predicted post-op refraction was identical to pre-op refraction in patients undergoing DSEK only

  4. Results • Average age - 60 • 10 Males, 10 Females • Average f/u time 287 days • No significant change in axial length (only measured in 2 patients) • No significant difference in pre-op or post-op Keratometry was observed when comparing DSEK eye to contralateral eye.

  5. Results Average change from predicted refractive error was 1.3D more hyperopic Average keratometry flattens by -0.52D (p<0.05) steeper flatter Pre-op Post-op No correlation between change in K’s from DSEK and change from predicted refraction

  6. Summary • A hyperopic shift of 1.3D is created by DSEK • Average K’s flatten by 0.5D after DSEK (p<0.5) • Flattening of keratometry was not statistically significantly correlated with the amount of induced hyperopia. However, a trend was observed since most eyes become flatter and more hyperopic. Pre-op Average K 43.5D POM #11 Average K 42.31D POM #4 Average K 42.12D

  7. Conclusions • Corneal flattening may contribute the hyperopic shift commonly observed after DSEK.

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