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Keratometric, Pachymetric, and Surface Elevation Characterization of Corneas With Fuchs Endothelial Corneal Dystrophy Treated With DMEK

Arnalich-Montiel, Francisco, PhD*,†; Mingo-Botín, David, PhD*; Diaz-Montealegre, Ana, MD*

doi: 10.1097/ICO.0000000000001875
Clinical Science

Purpose: To characterize pachymetric, keratometric, and surface elevation parameters in pseudophakic eyes with Fuchs dystrophy that underwent Descemet membrane endothelial keratoplasty (DMEK) and to compare these characteristics with those in normal pseudophakic eyes.

Methods: Postoperative corneal tomography with a median follow-up of 20 months was evaluated using the Pentacam tomographer on 46 DMEK eyes. Results were compared with data from an age-matched cohort of 46 normal eyes. Parameters included curvature analysis, keratometry values, corneal thickness (CT), pachymetric progression index, Ambrósio relational thickness, posterior elevation, and D-index values. Bonferroni correction was used for multiple comparisons.

Results: CT at the apex (mean difference 41 μm; 95% confidence interval 28–54) and CT at the thinnest point (46 μm; 33–60) were statistically significantly lower in the DMEK group (P < 0.001), whereas pachymetric progression index average (0.47; 0.32–0.62), Ambrósio relational thickness maximum (172; 126–228), IHD (0.096; 0.005–0.014), and the global D-index (1.03; 0.51–1.56) were significantly higher in eyes with DMEK (P < 0.001). The mean CT along the vertical and horizontal meridians was significantly lower in the DMEK group within the central 5 mm. A quarter and one half of the DMEK eyes had a CT of less than 500 μm at the apex or at the thinnest point, respectively.

Conclusions: Resolution of corneal edema after DMEK was associated with a thinner-than-normal central cornea, steeper pachymetric progression from the thinnest point to the periphery, and some high-end outliers for posterior elevation values. Caution should be exerted in planning corneal refractive surgery for residual refractive errors.

*Cornea Unit, Department of Ophthalmology, Ramón y Cajal University Hospital. Madrid, Spain; and

Hospital Oftalmológico Vissum Santa Hortensia, Madrid, Spain.

Correspondence: Francisco Arnalich-Montiel, PhD, Department of Ophthalmology, Hospital Universitario Ramón y Cajal, Carretera de Colmenar Viejo Km 9,100, 28034 Madrid, Spain (e-mail:

Supported in part by grants EC11-139 and PI15/01447 from the Ministry of Health and Social Politics, Spain.

The authors have no conflicts of interest to disclose.

Ethical approval: All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study, formal consent is not required.

Received September 03, 2018

Received in revised form December 02, 2018

Accepted December 08, 2018

Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.