the dmek triple: are we any closer to emmetropia? christopher s. sales, md, mph ; mark a. terry, md;...
TRANSCRIPT
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The DMEK Triple:Are We Any Closer to Emmetropia?
Christopher S. Sales, MD, MPH;
Mark A. Terry, MD; Zachary M. Mayko, MS;
Michael D. Straiko, MD
WCCVII, 2015
Portland, ORDeversEye InstituteD
The authors have no pertinent financial conflicts of interest to disclose.
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• We previously reported superior refractive predictability with the DLEK Triple compared to the PK Triple
• And even better refractive predictability with the DSAEK Triple
Background
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Purpose
• To determine whether the new DMEK Triple delivers predictable refractive outcomes compared to our previously reported results with the DSAEK Triple.
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Study Design
100 ConsecutiveDMEK Cases for Fuch’s
43 DMEK only57 Triple
Procedures
6 eyes excluded for factors confounding
visual acuity
51 Standard Cases
16 eyes excluded for myopic refractive
targets or unavailable 6-month data
35 eyes with 6-month follow-up and emmetropic
refractive targets
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Study Design
Devers Standardized DMEK technique• Pre-stripped tissue from the Lions VisionGift• S-Stamp• Overstripping of the recipient• Straiko glass injector• No-touch tap technique (DMEK “Dance”)• 20% SF6 bubble
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Study Design
• Emmetropia was targeted by selecting IOLs for a -0.70 D SE to account for the the hyperopic shift after DMEK
• Biometry was performed with the LenStar• BSCVA was measured with a Snellen
projector system
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Study Design
Primary Outcome Measures:• Manifest refraction
Secondary Outcome Measures:• CCT• BSCVA
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Results
Pre-Op 6 months400
450
500
550
600
650
604
524
Central Corneal Thickness After DMEK Triple
MIc
rons
* P <0.001
*
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Results
0
0.1
0.2
0.3
0.4
0.5
BSCVA After DMEK vs. DSAEK Triple
DSAEKDMEK
logM
AR
Pre-Op POM 6
20/52n=122
20/36n=35
20/24n=35
20/31n=122
*
** P <0.001
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Results
-1.25 -1 -0.75 -0.5 -0.25 0 0.25 0.5 0.75 1 1.25
0.11 ± 1.08 D(Range: -2.38 to
+5.00)
-0.28 ± 0.71 D(Range: -1.63 to
+1.25)Median: -0.50 D
SE 6-months After DMEK vs. DSAEK Triple
DMEK
DSAEK
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Results
< 1 D of Emmetropia0%
10%20%30%40%50%60%70%80%90%
100%
56%
74%
89%
Frequency of SE within < 1 D of of Emmetropia After DLEK vs. DSAEK vs. DMEK Triple
DLEK, 12 mo DSAEK, 12 mo DMEK, 6 mo
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Conclusions
• The DMEK Triple delivers a greater frequency of refractive outcomes within < 1 D of emmetropia than the DSAEK Triple
• This may be because DMEK achieves a more anatomic CCT and posterior corneal curvature
• Selecting IOL targets that account for anticipated shifts in CCT and corneal curvature might further optimize refractive predictability