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Summary Purpose Descemet membrane endothelial keratoplasty (DMEK) combined with cataract extraction and intraocular lens insertion (new triple procedure) limits postoperative refractive errors. The objective of this study was to assess refractive accuracy after DMEK combined with cataract extraction and intraocular lens implantation. Setting Four university hospitals (Rouen, Paris, Reims, Grenoble). Design This retrospective multicenter study included patients with symptomatic corneal endothelial decompensation and cataract. Methods The primary outcome was the difference between the target spherical equivalent and postoperative refraction at months 2 and 6. Secondary outcomes were visual acuity, keratometry, pachymetry and endothelial cell density. Results A total of 130 eyes of 111 patients (mean age 66.2 years) were included (94% with Fuchs’ endothelial dystrophy). For a mean refractive target set at −0.50 (±0.57) D, the mean (95% CI) refractive error was hyperopia of +0.49 (0.314; 0.664) D at 2 months and +0.46 (0.299; 0.619) D at 6 months. Best corrected distance visual acuity was improved in all patients: from 0.49 (±0.3) logMAR to 0.14 (±0.14) logMAR at 2 months and 0.05 (±0.1) logMAR at 6 months. Mean corneal thickness decreased from 621.6 (±37.6) μm to 515.2 (±42.6) μm at 2 months and 539.0 (±39.0) μm at 6 months. Conclusions Good refractive accuracy was obtained after the new triple procedure with DMEK. Hyperopic shift is common after triple procedures, and its persistence should be evaluated in future studies in order to anticipate a change in its value to optimize intraocular lens power calculation.

Sixteen four-member groups engaged in a problem-solving situation in which the goal was to maximize gains and minimize losses in a matrix type game. One of the members of each group, a trained confederate, independently varied his quantity and quality of verbal interaction in order to determine their importance in determining leadership emergence. While quality of verbal interaction was found to predict perceived differences on such variables as competence, influence, and contribution to the group's goal, only quantity of verbal interaction predicted perceived differences in leadership ability. The data suggest that this paradox may be due to quantity being a clearer indication of a group member's intentions than quality.