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

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 followup of 20 months was evaluated using the Pentacam tomographer on 46 DMEK eyes. Results were compared with data from an agematched cohort of 46 normal eyes. Parameters included curvature analysis, keratometry values, corneal thickness (CT), pachymetric progression index, Ambrosio relational thickness, posterior elevation, and D-index values. Bonferroni correction was used for multiple comparisons. Results: CT at the apex (mean difference 41 mm; 95% confidence interval 28-54) and CT at the thinnest point (46 mm; 33-60) were statistically significantly lower in the DMEK group (P, 0.001), whereas pachymetric progression index average (0.47; 0.32-0.62), Ambrosio 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 mm 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.