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No correlation has been shown between axial length or anterior chamber depth (ACD) and best corrected visual acuity after DMEK in prior studies. Prior studies have shown a correlation between shallow ACD and endothelial cell loss after DMEK. The purpose of this study is to examine the relationship between biometric data and DMEK attachment rate.
Retrospective chart review of consecutive combined DMEK/CE/IOL performed by a single surgeon from January 1, 2013 to December 31, 2019. Preoperative data collected included AL, ACD, white-to-white (WTW), lens thickness, and keratometric values (Zeiss IOLMaster). The primary outcome measurement was DMEK attachment rate. Secondary outcomes collected include time to DMEK detachment, re-bubble rate, additional surgeries needed, and final best corrected visual acuity. Multivariate analysis was performed. Statistical significance was defined as a p-value < 0.05.
248 eyes were included in the study. Partial detachment rate for all eyes in the study was 30.2%. The average axial length, anterior chamber depth, mean keratometry, and white-to-white of attached DMEK grafts versus partially detached DMEK grafts was 24.17 +/- 1.35 mm vs. 23.79 +/- 1.31 mm (p=0.039), 3.22 +/- 0.42 mm vs. 3.17 +/- 0.38 mm (p=0.420), 43.40 +/- 2.26 D vs. 44.04 +/- 1.55 D (p=0.028), and 12.15 +/- 0.99 mm vs. 12.10 +/- 0.44 mm (p=0.702), respectively. Eyes with mean keratometry over 43.5 diopters had a partial detachment rate of 35%, while eyes with mean keratometry less than 43.5 had a partial detachment rate of 23% (p=0.045).
Steeper keratometry and shorter axial length were associated with a significantly higher rate of DMEK detachment. This could be utilized in pre-operative counseling when discussing patients’ risk of requiring a re-bubbling procedure post-operatively.
This presentation is from the session "SPS-101 Corneal Procedures & Diagnostics: EK, PK, CXL, Other" from the 2020 ASCRS Virtual Annual Meeting held on May 16-17, 2020.