Official ESCRS | European Society of Cataract & Refractive Surgeons


Refractive outcomes in combined cataract surgery and Descemet's membrane endothelial keratoplasty (phacoDMEK)

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Session Details

Session Title: Cornea Surgical: Lamellar Corneal Grafts

Session Date/Time: Tuesday 17/09/2019 | 08:30-10:30

Paper Time: 09:24

Venue: Free Paper Forum: Podium 3

First Author: : Benito-Llopis UK

Co Author(s): :    S. Koay                             

Abstract Details


Changes in corneal curvature are induced following DMEK, which can make intraocular lens power selection more challenging if cataract surgery is performed at the same time. DMEK has been described to cause a hyperopic shift, and therefore surgeons tend to aim for a myopic outcome when choosing the lens. This study was performed to compare the planned and achieved refractive outcomes in patients undergoing a phacoDMEK procedure.


Department of Cornea and External Diseases, Moorfields Eye Hospital, London, United Kingdom


Retrospective review of data collected on consecutive patients who underwent phacoDMEK in our institution during 2017 and who came for their 1 year postoperative review. Only those with data on the aimed refractive outcome and a full refraction done by an optometrist postoperatively were included. We compared the planned versus achieved refractive outcomes. Those patients with failed grafts were excluded from the study.


271 patients underwent DMEK in our institution during 2017. Amongst these, 36 eyes of 36 patients fulfilled the inclusion criteria and were analysed. The mean planned spherical equivalent was -0.54 ±0.39D (range between -0.10 and -2.16). Only 17% eyes achieved a postoperative spherical equivalent within 0.50D of intended, and 44% were within 1.00D. The mean difference between planned and achieved spherical equivalent was +1.04 ± 1.05 (range -2.34D to +3.12D). 89% had a hyperopic difference between planned and achieved refraction, which ranged from +0.16D to +3.12D. 78% of eyes had a hyperopic difference of more than +0.5D.


In our series, combined phacoDMEK surgery seemed to offer low refractive predictability, with most eyes showing a higher hyperopic shift than expected. This suggests that aiming for a more myopic refractive target may help to reduce the proportion of eyes left hyperopic postoperatively.

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