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We are grateful to the authors of “Elimination of Anterior Corneal Steepening With Descemet Membrane Endothelial Keratoplasty in a Patient With Fuchs Dystrophy and Keratoconus: Implications for IOL Calculation” for their important insight; namely that the traditional belief that anterior corneal curvature remains unchanged by Descemet membrane endothelial keratoplasty (DMEK) may not be universally true, and that—under exceptional circumstances—some alterations in surface topography may be observed.1
Recently, other similar and corroborating reports have also been published, including several documenting surface flattening after DMEK in eyes with previous laser in situ keratomileusis.2,3 At our facility, we have likewise encountered these occasional topographic anomalies, which may be more common in corneas with compromised stromal support fibers (e.g., in eyes with previous laser in situ keratomileusis or keratoconus).
Earlier this year, we observed 2-D steepening of the anterior cornea after surgery, which agrees with their claim that the anterior cornea may be more labile than previously believed but disagrees with their conclusion regarding how to modify intraocular lens calculations for combined cataract surgery.4 A larger scale study may be helpful to further clarify the variability in effect, and—more generally—a study of “DMEK after refractive surgery” (e.g., photorefractive keratectomy and radial keratotomy) may also be most useful to cataract surgeons.
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