Changes in Corneal Power Up to 2 Years after Endothelial Keratoplasty: Results from the Randomized Controlled Descemet Endothelial Thickness Comparison Trial

center dot PURPOSE: To compare changes in corneal power mea-surements after Descemet membrane endothelial kerato-plasty (DMEK) vs ultrathin Descemet stripping auto-mated endothelial keratoplasty (UT-DSAEK). center dot DESIGN: Post hoc subanalysis of the randomized controlled Descemet Endothelial Thickness Comparison Trial. center dot METHODS: A total of 50 eyes (38 patients) with en-dothelial dysfunction from Fuchs' endothelial dystrophy or pseudophakic bullous keratopathy were randomized to DMEK or UT-DSAEK 1 to 2 days before surgery. Total corneal refractive power (TCRP) and anterior/posterior simulated keratometry were obtained using Scheimpflug imaging preoperatively (baseline) and postoperatively at 3, 6, 12, and 24 months. Spectacle refractions were per-formed at 6, 12, and 24 months after surgery. Setting: Hospital centers.center dot RESULTS: The mean hyperopic shift of TCRP from baseline to 12 months was 0.80 +/- 1.1 ( P = .002) in the DMEK group and 0.69 +/- 0.84 ( P < .001) in the UT-DSAEK group. Posterior corneal curvature (aver-age K from simulated keratometry) steepened (more neg-ative dioptric power) by 0.42 +/- 0.10 ( P < .001) in DMEK and 0.54 +/- 0.09 ( P < .001) in UT-DSAEK. The mean change in TCRP and posterior corneal curvature did not differ between DMEK and UT-DSAEK (TCRP, P = .71; posterior average K from simulated keratometry, P = .36). center dot CONCLUSIONS: Sustained steepening in posterior corneal curvature with loss in total corneal power con-tributes to hyperopic shifts after endothelial keratoplasty. Changes in corneal measurements do not differ between DMEK and UT-DSAEK. NOTE: Publication of this ar-ticle is sponsored by the American Ophthalmological So-ciety. (Am J Ophthalmol 2023;245: 233-242. (c) 2022 Elsevier Inc. All rights reserved.)