Model of Hyperopic Shift After DSEK

Slides:

Advertisements

Similar presentations

Femtosecond Laser–Assisted Sutureless Anterior Lamellar Keratoplasty

Advertisements

Comparison of Endothelial Cell Count by Manual and Automated Methods in Normal Corneas and in Fuchs' Endothelial Dystrophy Somasheila I Murthy, Debarun.

Venting Incisions in DSAEK Patients: Is It an Absolute Necessity?

Use of a Novel Y- Suture Technique to Reduce Detachments in Descemet’s Stripping Automated Endothelial Keratoplasty (DSAEK) Habeeb Ahmad, MD Martin Heur,

Steve Schallhorn MD Myth Busters in Patient Selection for LASIK Steve Schallhorn MD.

Retrospective comparison of staged versus combined cataract surgery and Descemet’s-stripping endothelial keratoplasty (DSEK) in patients with Fuchs’ Dystrophy.

Relationship Between Donor Graft Cell Count and Visual Outcome in DSAEK Patients Authors Silvin Bakalian MD PhD, Johanna Choremis MD FRCSC, Michele Mabon.

V. S. Liarakos, K. van Dijk, L. Ham, L. Baydoun and G.R.J. Melles Anterior Chamber vs Posterior Chamber IOL in DMEK for Pseudophakic Bullous Keratopathy.

Corneal Densitometry and Visual Outcome Comparisons of DSAEK and DMEK Eyes Xiaolin Zhang MD Robert L. Schultze MD Robert A. Eden MD Rahul Raghu.

IOL power calculation after refractive surgery A. Peyman, MD.

Dislocation of the DSEK Donor Graft into the Posterior Segment An Intraoperative Complication in DSEK Surgery Mark M Fernandez MD, Mark S Gorovoy MD, George.

Richard Y. Hwang 1, PhD; Dan Gauthier 2, PhD; Dana Wallace 1, MD; Natalie A. Afshari 1, MD 1 Department of Ophthalmology, 2 Department of Physics Duke.

Correction of Astigmatism with Toric IOL After Previous RK

Bryan Y Kim 1, Shintaro Kanayama MD PhD 1, Tueng T Shen MD PhD 1, Thomas E Gillette MD 2 1 University of Washington Department of Ophthalmology, 2 Eye.

Dept. of Ophthalmology, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany. Outcome after big-bubble deep anterior lamellar keratoplasty.

G. Jacob 1,2, C. Bouchard 2, S. Kancherla 1. Edward Hines, Jr. VA Hospital, Hines, IL, Department of Ophthalmology 1. Loyola University Medical Center,

Evaluation of Corneal Parameters and Spherical Aberration After DSAEK Measured with Pentacam System Orkun Muftuoglu, Pawan Prasher, R. Wayne Bowman, Steven.

Evaluation of Zonal Equivalent Keratometry Readings After LASIK Timmy Kovoor, MD Orkun Muftuoglu, MD V.Vinod Mootha, MD Steven Verity, MD R. Wayne Bowman,

Urrets-Zavalia Syndrome Following Descemet Stripping Endothelial Keratoplasty Claire Y. Chu, MD Pawan Prasher, MD Eric Dai, MD R. Wayne Bowman, MD V. Vinod.

Anterior Segment Optical Coherence Tomography and In Vivo Confocal Microscopy Findings in Femtosecond Laser- Assisted Keratoplasty Kurt H. Kelley, MD;

Case Report of Severe Haze After DSAEK

“Tuck In” Lamellar Keratoplasty (TILK) for Post-Keratoplasty Corneal Ectasia involving the Corneal Periphery Vishal Jhanji, MD 1,2 Jacqueline Beltz, MBBS,

Epithelial Ingrowth Following Endothelial Keratoplasty Ritika Dalal, DNB Robert S. Feder, MD, Irving Raber, MD, Steven P. Dunn, MD, Robert Weisenthal,

Endothelial Keratoplasty in Patients With an Anterior Chamber Intraocular Lens: A Montreal Experience Georges M. Durr, MD 1,2 Johanna Choremis, MD, FRCSC.

The Effect of Corneal Anterior Surface Eccentricity on Astigmatism after Cataract Surgery Choul Yong Park MD 1 Sung Jun Lee MD 1 Prabjot Channa MD 2 Roy.

Biomechanical and Optical Behavior of Human Corneas Before and After Photorefractive Keratectomy Anna Pandolfi, Politecnico di Milano, Italy Paolo Sanchez,

King Saud University College of Medicine

Nang-Hee Song(MD) 1, Jae-Woong Koh (MD/PhD) 1, Gil-Joong Yoon (MD/PhD) 2 Department of Ophthalmology, Chosun University College of Medicine, Gwangju, Republic.

Daniel D. Hayes, MD1; Carolyn Y. Shih, MD1; David C

Effect of an irregular anterior surface on a lamellar femtosecond laser cut Robert E. Fintelmann, MD Michele M. Bloomer, MD Bennie H. Jeng, MD Authors.

Comparison of Central Corneal Thickness, Anterior Chamber Depth, and Central Corneal Power Measurements between Two Scheimpflug Imaging Systems Yuichi.

DSEK for the treatment of endothelial disease in India -Initial Experience in 80 eyes- Authors have no financial interest Dr Ashish Nagpal MD, FRCS Dr.

Comparison of Endothelial Keratoplasty (EK) Visual Outcomes with OCT Derived Corneal Thickness Measurements Authors Abraham K. Sleem, MD Robert L. Schultze,

Dorota Tarnawska, MD Dariusz Dobrowolski, MD Dominika Janiszewska

Long Term Results of Femtosecond Laser-Assisted Sutureless Anterior Lamellar Keratoplasty “FALK” Mohamed Abou Shousha, MD, Sonia H. Yoo, MD, William Feuer,

Predicting Visual Acuity after Descemet’s Stripping Endothelial Keratoplasty using Corneal Topography, Pachymetry and Posterior Curvature Asymmetry Indices.

Corneal Endothelial Cell Changes After LASIK Using a Femtosecond Laser Minoru Tomita, MD, PhD, Masaru Aoyama, MD, Minoru Tomita, MD, PhD, Masaru Aoyama,

John P Berdahl M.D.* David R. Hardten M.D., F.A.C.S.* *No relevant financial disclosures.

Date of download: 6/22/2016 Copyright © 2016 American Medical Association. All rights reserved. From: Effects of Graft Thickness and Asymmetry on Visual.

Effect of Donor Processing and Storage Time and Preoperative Endothelial Cell Counts on DSAEK Detachment Rates Daniel Demsey BScE Stephanie Baxter MD,

Intrastromal Ring Segments for Keratoconus: A Retrospective Review Brad Feldman MD, Alan Carlson MD, Terry Kim MD, Natalie Afshari MD, Ricardo Santaella.

Department of Ophthalmology, University of Ulsan College of Medicine,

CORNEAL EPITHELIAL IMAGING

Measurement of 60 kHz Femtosecond LASIK Flaps with Anterior Segment Ocular Coherence Tomography & Ultrasonic Subtraction Pachymetry Edward E. Manche, MD.

Corneal Pachymetry in Prediction of Refraction After Cataract Surgery

Special considerations for DSEK in monocameral eyes

Comparative analysis of total ocular aberrations and posterior corneal surface metrics following ultra-thin manual Descemet’s striping endothelial keratoplasty.

Refractive outcomes of intraoperative wavefront aberrometry versus optical biometry alone for intraocular lens power calculation Zina Zhang MD1, Logan.

Nienke Visser, Tos T.J.M. Berendschot, Rudy M.M.A. Nuijts

Endothelial keratoplasty in failed grafts

Early Experience with Descemet’s Stripping Automated Endothelial Keratoplasty Combined with Phacoemulsification: Clinical and Refractive Outcome University.

Mehdi Ghajarnia, MD Mark Mifflin, MD John A. Moran Eye Center

Anil Vedula MD Financial Disclosures: None Richard M. Awdeh MD

Clinical outcome of thin corneas after laser in situ keratomileusis

Hong A, Boehlke CS, Afshari NA, Kim T Duke University Medical Center

Is Photorefractive Keratectomy the Laser Vision Correction of Choice?

Roxana Ursea, MD Matthew T. Feng, MD Ovette Villavicencio, PhD

Sun Woong Kim, M.D.1, Hae Jung Sun, M.D.1,

IN THE NAME OF GOD.

DARIUSZ DOBROWOLSKI¹, EDWARD WYLĘGAŁA¹ ², DOROTA TARNAWSKA¹

Glaucoma Progression after Descemet’s Stripping Endothelial Keratoplasty Neelofar Ghaznawi MD, Melissa B Daluvoy MD, Ajoy Virdi MD, Edwin S Chen, Kristin.

Role of HSV Infection in the Histopathology of Failed DSAEK

Dr Ciara Bergin, PhD Dr Ivo Guber, Dr Kate Hashemi, Dr Francois Majo

Anand K Shah MD1 Neda Shamie MD1 Paul Phillips MD1 Mark A Terry MD1,2*

I.J.E van der Meulen1, C.P. Nieuwendaal1,

University of Texas Southwestern Medical Center at Dallas, Texas

Matthew Caldwell, Alan Proia, Francis DeCroos, and Natalie Afshari

Refractive Surgery Outcomes: Corneas Thinner than 500 microns Vs

Brian R Will, MD Adjunct Clinical Professor of Ophthalmology

Presentation transcript:

Model of Hyperopic Shift After DSEK Dana Wallace MD, Richard Hwang BS, and Natalie Afshari MD Duke University Eye Center The authors have no financial interests to disclose.

DSEK: A refractive neutral procedure? Partial posterior lamellar transplant indicated in patients with endothelial dysfunction Sutureless No astigmatic effect Now known to induce a hyperopic shift Implications on “triple” procedures (CE/IOL/DSEK) Covert DJ and Koenig SB. Ophthalmology 2007; 114:1272-1277. Koenig SB and Covert DJ. Ophthalmology 2007;114:221-226. Jun et al. Cornea 2009; 28: 19-23.

Purpose Changes in posterior curvature are responsible for the hyperopic shift that occurs in DSEK. The magnitude of this shift remains unpredictable. To derive a mathematical model that can be used preoperatively to predict the observed hyperopic shift after DSEK. Gorovoy MS. Cornea 2006; 25:886-889. Koenig SB, et al. Cornea 2007; 26: 670-674. Price FW Jr, Price MO. J Refract Surg 2005; 21:339-345.

Methods Based on the assumptions of the thick lens equation and the Gullstrand model eye, we developed a mathematical model to predict the hyperopic shift that occurs after DSEK based on preoperative pachymetry and endothelial graft thickness.

Dcornea = Dant + Dpost - (d/n)(Dant)(Dpost) Formula Dcornea = Dant + Dpost - (d/n)(Dant)(Dpost) Dant = refractive power of anterior surface = (1/r1)(nant-nair) r1 = radius of curvature of anterior surface Dpost= refractive power of posterior surface = (1/r2)(nant-naq) r2 = radius of curvature of posterior surface d = corneal thickness n = refractive index

As applied to DSEK… Preoperative corneal power Determined by preoperative pachymetry Postoperative corneal power Graft thickness of the graft was added to the corneal pachymetry Graft thickness of the graft was subtracted from the posterior radius of curvature The difference in these calculations reveals a hyperopic shift.

As applied to patients… Preop Mrx Preop Pachymetry (μm) Graft Thickness (μm) Predicted Hyperopic Shift Observed Hyperopic Shift 1 0.00-0.50x092 643 103 +0.07 +1.25 2 +0.25-1.25x105 640 100 +0.06 +0.96 3 0.00-0.25x165 142 +0.09 +0.375 Calculations were only performed in pseudophakic eyes.

Dcornea = (naq-nair)/radius of curvature Interestingly, if we use the eye as only one refractive surface, the model is more accurate. Dcornea = (naq-nair)/radius of curvature Patient Preop Mrx Preop Pachymetry (μm) Graft Thickness (μm) Predicted Hyperopic Shift Observed Hyperopic Shift 1 0.00-0.50x092 643 103 +0.58 +1.25 2 +0.25-1.25x105 640 100 +0.56 +0.96 3 0.00-0.25x165 142 +0.80 +0.375

Other Factors to Consider Endothelial graft is thicker peripherally than centrally In the first few postoperative months, the graft edges thin faster than the vertex

A more accurate “r2” Can current imaging modalities facilitate these measurements? Pentacam Anterior Segment OCT Can we use a model of an ellipse to more accurately predict r2?

Conclusions The hyperopic shift induced by DSEK is the result of changes in corneal thickness and posterior radius of curvature Prediction of the hyperopic shift induced by DSEK is critical in the planning of refractive outcomes Advances in anterior segment imaging will aid in more accurate prediction of refractive outcomes