The Upcoming Technology Revolution in Refractive Surgery DMEK

Near complete visual recovery and refractive stability in modern corneal transplantation

The Upcoming Technology Revolution in Refractive Surgery DMEK

cutting-edge concepts in refractive surgery, ranging from presbyopia correction to innovations in laser refractive surgery and beyond, Descemet membrane endothelial keratoplasty, DMEK

Descemet membrane endothelial keratoplasty has been adopted worldwide as an alternative to penetrating keratoplasty in the treatment of corneal endothelial disorders. Descemet stripping (automated) endothelial keratoplasty (DSEK/DSAEK) may be the current standard, whereas Descemet membrane endothelial keratoplasty (DMEK), that is, isolated transplantation of Descemet membrane, may allow further improvement of clinical outcome endothelial keratoplasty (DMEK).

What Is DMEK?

DMEK is a partial-thickness cornea transplant procedure that involves selective removal of the patient’s Descemet membrane and endothelium, followed by transplantation of donor corneal endothelium and Descemet membrane without additional stromal tissue from the donor. The graft tissue is merely 10-15 microns thick

Why do you need this type of surgery

Descemet’s membrane endothelial keratoplasty (DMEK) is an operation intended to restore corneal clarity in cases where the innermost corneal layer (the endothelium) has failed. Endothelial failure most commonly arises as a result of previous eye surgery, e.g. cataract or glaucoma operations. It may also occur spontaneously in a condition called ‘Fuch’s endothelial dystrophy’. This is a genetic condition, although not always inherited, whereby patients do not have enough cells to last for life.

Patients develop symptoms between the ages of 40 and 60, often in both eyes.

How Does DMEK treat Endothelial failure?

DMEK is an operation in which the failing endothelium is selectively replaced with a donor graft, leaving only the healthy part of the cornea in place. The donor cornea heals onto the patient’s cornea and pumps fluid out of it, clearing the vision. DMEK is a development of a well-established procedure called ‘Descemet’s stripping endothelial keratoplasty’, or ‘DSEK’. In DSEK a very fine layer of endothelium and supporting tissues, approximately 0.1 mm. thick, is removed from a donor cornea. The unhealthy endothelium is then stripped from the patient’s eye. The donor endothelium is gently rolled and inserted into the eye, where it unrolls and is floated into position. It sits in place without stitches because its fluid pumping action sucks it into position. The difference with DMEK is that the donor endothelium is removed with only its backing layer (Descemet’s membrane), with no carrier corneal stroma. This means that the donor graft is only 20 microns thick (20/1000mm).

The Advantage of DMEK

DMEK offers the most complete, rapid visual rehabilitation of any keratoplasty technique to date. Final visual acuity can be outstanding due to minimal optical interface effects. Because less tissue is transplanted, there is a lower risk of allograft rejection and less long-term reliance on topical steroids compared with other types of keratoplasty. Discontinuation of topical steroids can be considered at or before 1 year after the procedure, especially for patients with elevated intraocular pressure.