*Correspondence, Radhika Patel: radhika.patel6@nhs.net

Background Combining cataract surgery with Descemet’s membrane endothelial keratoplasty (DMEK) surgery compared to staged surgeries provides a cost-effective method with faster visual rehabilitation and is more convenient for the patient. However, the combined procedure can lead to a refractive shift that can be difficult to predict. We aimed to assess the refractive outcomes of our patients.

Methods All patients who underwent combined DMEK procedures with phacoemulsilfication and insertion of IOLs between January 2016 and October 2022 were identified using the Medisoft audit tool. Data including demographics, keratometry, postoperative refraction and refractive aim were obtained.

Results Twenty eyes which underwent combined procedure for Fuchs’ endothelial dystrophy were included. The average age was 72.4 years (range 60–95) and 70% were female (n=14). Eighteen (90%) of patients had improved visual acuity postoperatively with a mean improvement of 0.4 LogMAR overall. The average change in predicted outcome was a hyperopic shift of +0.55D (range -0.99 to +2.49D) with 65% (n=13) of patients achieving a more hyperopic outcome than aimed for. Three patients who achieved +1.50D over the predicted outcome had steeper K-readings of >46D, however, there was no other significant difference in K-readings between the patients who achieved a more myopic outcome and those that that achieved a hyperopic outcome.

Conclusion Refractive outcomes of patients undergoing combined cataract and DMEK surgery can be unpredictable. We suggest aiming for a more myopic target (such as -1.00D instead of -0.50D) in these patients may better protect against an unfavourable hyperopic outcome particularly in this age group.