Purpose: To determine the refractive change and stability of the transplanted cornea after Descemet membrane endothelial keratoplasty (DMEK) through a 3.0 mm clear corneal incision. Setting: Tertiary referral center. Design: Cohort study. Methods: Subjective and objective refractive data from pseudophakic eyes were obtained before and 3 and 6 months after DMEK. Results: The study comprised 50 eyes, 7 were phakic and 43 pseudophakic. Six months postoperatively, the corrected distance visual acuity was 20/25 (0.8) or better in 38 eyes (74%). The mean increase in spherical equivalent at 6 months (N = 50) was +0.32 diopter (D) ± 1.01 D (SD) (P=.0304) and in refractive cylinder, -0.48 ± 1.02 D (P=.001). Although Scheimpflug imaging showed a stable anterior corneal curvature, the posterior curvature increased from 5.50 ± 0.5 D preoperatively to 6.40 ± 0.4 D at 6 months and pachymetry decreased from 672 ± 82 μm to 540 ± 59 μm, respectively (both N = 32) (both P=.000). Conclusions: After DMEK, a slight preoperative to postoperative refractive change and stabilization at 3 months occurred that may induce a hyperopic shift that was not the result of the negative lenticule effect of DSEK/DSAEK. Thus, in DMEK, the hyperopic shift may result from a reversal of a preceding myopic shift induced by stromal swelling in endothelial disease. If so, normal intraocular power nomograms apply for cataract surgery before or during DMEK. Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned. Additional disclosures are found in the footnotes.