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Innovations in Descemet Membrane Endothelial Keratoplasty (DMEK)

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Modern Keratoplasty

Part of the book series: Essentials in Ophthalmology ((ESSENTIALS))

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Abstract

Descemet membrane endothelial keratoplasty (DMEK), a technique which selectively replaces diseased Descemet membrane (DM)-endothelium with healthy donor DM-endothelium only, is emerging as the preferred choice of endothelial keratoplasty in patients with corneal endothelial diseases. It has the advantages of quicker recovery, lower graft rejection rate, better visual outcome, and reduced need for topical steroids (hence a lower risk of glaucoma) compared to penetrating keratoplasty and Descemet stripping automated endothelial keratoplasty (DSAEK). However, DMEK is associated with a steeper learning curve and a reportedly higher rate of postoperative complications, including graft detachment requiring postoperative re-bubbling and primary graft failure, when compared to DSAEK. In view of the challenges, various improvement and modifications have been described to further refine the surgical techniques of DMEK, with an aim to reduce complications and improve clinical outcomes. In this chapter, we provide an overview of recent innovations in DMEK, including donor insertion (endothelium-out) and pull-through (endothelium-in) devices/techniques, the use of intraoperative optical coherence tomography and other novel DMEK techniques for complex eyes, including those with shallow anterior chamber, aphakia and/or significant iris defect.

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Authors and Affiliations

  1. Birmingham and Midland Eye Centre, Birmingham, UK

    Darren S. J. Ting

  2. Academic Unit of Ophthalmology, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK

    Darren S. J. Ting

  3. Academic Ophthalmology, School of Medicine, University of Nottingham, Nottingham, UK

    Darren S. J. Ting

  4. Singapore National Eye Center, Singapore Eye Research Institute, Singapore, Singapore

    Marcus Ang

  5. Department of Ophthalmology and Visual Sciences, Duke-NUS Medical School, Singapore, Singapore

    Marcus Ang

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  1. Darren S. J. Ting
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Editors and Affiliations

  1. Vissum Miranza, Miguel Hernández University, Alicante, Spain

    Jorge L. Alió

  2. Vissum-Instituto Oftalmologico de Alica, Miguel Hernandez University, Alicante, Alicante, Spain

    Jorge L. Alió del Barrio

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Endothelium-in DMEK surgery in difficult view (MP4 258554 kb)

Use of iOCT and light pipe for endothelium-out DMEK (MP4 290767 kb)

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Ting, D.S.J., Ang, M. (2023). Innovations in Descemet Membrane Endothelial Keratoplasty (DMEK). In: Alió, J.L., del Barrio, J.L.A. (eds) Modern Keratoplasty. Essentials in Ophthalmology. Springer, Cham. https://doi.org/10.1007/978-3-031-32408-6_29

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