Hyperopic Shift After Descemet Membrane Endothelial Keratoplasty (Dmek): Implications For Intraocular Lens Power Selection

To evaluate the magnitude and consistency of postoperative hyperopic shift following Descemet membrane endothelial keratoplasty (DMEK) and to discuss its clinical implications for intraocular lens (IOL) power selection in combined or sequential cataract surgery. Accurate refractive targeting in endothelial keratoplasty remains challenging due to postoperative corneal shape changes, particularly posterior corneal steepening.

Single-centre retrospective cohort study conducted at a tertiary cornea and cataract surgery unit, including patients undergoing DMEK with either prior cataract surgery or combined DMEK–phacoemulsification (triple procedure).

A total of 94 eyes of 88 patients undergoing DMEK between January 2021 and June 2024 were analysed. Indications included Fuchs endothelial corneal dystrophy and pseudophakic bullous keratopathy. Eyes were grouped into: (A) pseudophakic DMEK and (B) combined DMEK–phaco–IOL implantation. Preoperative and postoperative refraction, keratometry, posterior corneal curvature and corneal thickness were recorded. The primary outcome was spherical equivalent (SE) change at 6 months. Secondary outcomes included changes in posterior corneal power and comparison between groups. Statistical analysis used paired t-tests and subgroup analysis.

Mean postoperative refractive shift at 6 months showed a significant hyperopic shift of +0.42 ± 0.31 D across the cohort (p < 0.001). Hyperopic shift was more pronounced in the combined DMEK–phaco group (+0.48 D) compared to pseudophakic DMEK (+0.36 D). Posterior corneal curvature demonstrated significant steepening following DMEK, correlating with refractive change. Variability of shift ranged from +0.10 to +1.10 D. No association was found between donor thickness and refractive shift.

Mean postoperative refractive shift at 6 months showed a significant hyperopic shift of +0.42 ± 0.31 D across the cohort (p < 0.001). Hyperopic shift was more pronounced in the combined DMEK–phaco group (+0.48 D) compared to pseudophakic DMEK (+0.36 D). Posterior corneal curvature demonstrated significant steepening following DMEK, correlating with refractive change. Variability of shift ranged from +0.10 to +1.10 D. No association was found between donor thickness and refractive shift.