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Astigmatic changes before decompensation and after DMEK surgery were compared using anterior and posterior keratometry and True Net Power (TNP) in corneal tomography (Pentacam, Oculus). The differences in magnitude of astigmatism and axis of steep meridian were calculated by algebraic and vectorial methods, and significant differences to specified thresholds were determined by the non\u2010parametric Wilcoxon rank test.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Surgically induced changes (SIC) in magnitude of astigmatism at anterior surface, posterior surface and TNP were \u22121.4dpt\u2009\u00b1\u20093.7, \u22120.2dpt\u2009\u00b1\u20090.8 and \u22121.3dpt\u2009\u00b1\u20093.9, respectively. No significant changes in astigmatism and axis difference by algebraic method in comparison with a hypothetical median of 0dpt and 10\u00b0 were observed. Calculation of astigmatism difference by vectorial method showed a significant deviation in anterior surface (observed median\u2009=\u20094.4dpt,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001), posterior surface (observed median 1.0dpt,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.012) and TNP (observed median\u2009=\u20093.6dpt, p\u2009&lt;\u20090.001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Even if no significant change in magnitude and axis of astigmatism to acceptable thresholds could be shown after DMEK in failed PK using the algebraic method, there is a significant and relevant change in magnitude of astigmatism using the vectorial calculation. Based on these results, caution is advised when using toric intraocular lenses in PK eyes, as astigmatic change is expected when performing DMEK on eyes with failed PK.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/aos.70081","type":"journal-article","created":{"date-parts":[[2026,2,11]],"date-time":"2026-02-11T09:30:42Z","timestamp":1770802242000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Astigmatic changes after Descemet membrane endothelial keratoplasty (\n                    <scp>DMEK<\/scp>\n                    ) in decompensated penetrating keratoplasty grafts"],"prefix":"10.1111","volume":"104","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4019-8686","authenticated-orcid":false,"given":"Florian Thomas","family":"Steinberg","sequence":"first","affiliation":[{"name":"Department of Ophthalmology Medical Faculty and University Hospital of Cologne  Cologne 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