This study aims to assess visual anatomic outcomes and complications of Descemet Membrane Endothelial Keratoplasty (DMEK) combined with phacoemulsification and intraocular lens implantation in patients with coexisting endothelial dysfunction and cataract. Methods:Triple DMEK (DMEK with simultaneous cataract surgery) was performed in 39 eyes of the 32 patients. Best-corrected Visual Acuity (BCVA), Endothelial Cell Density (ECD), Central Corneal Thickness (CCT), Refractive Spherical Equivalent (RSE), air injections (Re-bubbling) frequency and complications were assessed preoperatively and postoperative months 1, 3, 6 and 12.Results: BCVA increased from 1.22±0.32 logMAR preoperatively to 0.19±0.18 (n=33) and 0.11±0.09 (n=27) at six months and 12 months after surgery, respectively (p<0.05; Wilcoxon test). The mean ECD of donor corneas decreased from 2771±284 cell/mm 2 (n=39) to 1401±270 cell/mm 2 (n=32) after six months and to 1373±217 cell/mm 2 (n=24) after 12 months (p<0.05). Preoperative CCT decreased from 696±99 µm and to 518±42 µm and 517±35 µm 6 and 12 months after surgery, respectively (p<0.05). The mean RSE was -0.57±0.69 D (n=21) preoperatively and +0.47±0.65 D (n=31) and 0.48±0.67 D (n=27) 6 and 12 months after surgery. The mean RSE was detected ≤1D in 82% of the patients at 12 th month. Re-bubbling was performed once in seven eyes (17.9%) and twice in two eyes (5.12%). Re-DMEK was performed in six of seven eyes of which graft failure developed, whereas penetrating keratoplasty was performed in one eye. Conclusion:Triple DMEK may consistently give predictable refractive results without adverse endothelial function. Hence, triple DMEK can be considered as the primary treatment approach in cases with endothelial dysfunction and cataract.