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Changes in Anterior and Posterior Corneal Astigmatism after Descemet Membrane Endothelial Keratoplasty versus Ultrathin Descemet Stripping Automated Endothelial Keratoplasty: Results from the Randomized Controlled DETECT Trial

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Posterboard#: B0345

Abstract Number: 6294 - B0345

AuthorBlock: Samuel Werner1, Jennifer Rose-Nussbaumer2, Charles Lin3, Ariana Austin2, Winston Chamberlain1
1Cornea, Casey Eye Institute, Oregon Health and Science University, Portland, Oregon, United States; 2Ophthalmology, University of California, San Francisco, California, United States; 3Ophthalmology, Stanford University, Palo Alto, California, United States;

DisclosureBlock: Samuel Werner, None; Jennifer Rose-Nussbaumer, None; Charles Lin, None; Ariana Austin, None; Winston Chamberlain, None;

Purpose
Refractive outcomes after endothelial keratoplasty can be difficult to predict, especially when paired with cataract surgery. Previous retrospective studies have suggested varying degrees of corneal curvature impact from Descemet Membrane Endothelial Keratoplasty (DMEK) and Descemet Stripping Automated Endothelial Keratoplasty (DSAEK), but to our knowledge the effect of these procedures on corneal astigmatism has not been examined with a randomized controlled trial or in ultrathin (UT) DSAEK. We examined the changes in anterior and posterior corneal astigmatism in patients who enrolled in the Descemet Endothelial Thickness Comparison (DETECT) Trial, a randomized-controlled trial comparing DMEK and UT-DSAEK.

Methods
A total of 50 eyes of 38 patients with isolated endothelial dysfunction were randomized by the eye bank to receive DMEK or UT-DSAEK. Anterior and posterior corneal simulated keratometer (SimK) data for 39 eyes was obtained using Scheimpflug Imaging (Oculus Pentacam®). Two-sided Wilcoxon signed-ranked tests were used to compare baseline astigmatism to post-operative 12-month measurements in 19 DMEK and 20 UT-DSAEK eyes.

Results
In the DMEK group, there was no difference in anterior astigmatism between baseline and 12 months after surgery (p=0.79), but there was a significant difference in posterior corneal astigmatism (p=0.018). In the UT-DSAEK group, there was no difference was detected in anterior or posterior astigmatism between baseline and 12 months after surgery (p= 0.49, p=0.16, respectively). There was no difference in anterior or posterior astigmatism between DMEK and UT-DSAEK groups at 12 months (p=0.26, p=0.06, respectively).

Conclusions
DMEK and UT-DSAEK were not associated with a post-operative shift in anterior corneal astigmatism, the dominant refractive surface of the cornea, despite changes in refractive outcome known to occur after endothelial keratoplasty. DMEK was associated with a post-operative shift in posterior corneal astigmatism but not UT-DSAEK.

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