Hyperopic shifts and anterior curvature flattening after Descemet-stripping endothelial keratoplasty and cataract surgery in 2 patients with a history of myopic LASIK

Abstract

Two patients with a history of myopic laser in-situ keratomileusis (LASIK) experienced larger-than-expected hyperopic results after cataract surgery and Descemet-stripping endothelial keratoplasty (DSEK) for Fuchs endothelial corneal dystrophy. Although an anticipated hyperopic shift from DSEK-related posterior curvature steeping was taken into account during IOL power calculations, the refractive outcome was still more hyperopic than expected. Postoperative analysis revealed significant and unexpected flattening of the anterior corneal curvature that is not common after standard DSEK. Central anterior stromal ablation from myopic LASIK might make the cornea more prone to swelling and anterior steepening as Fuchs dystrophy progresses, increasing corneal power. A subsequent reduction in swelling might then cause central flattening and contribute to hyperopic errors after combined cataract–endothelial keratoplasty surgery.