Descemet's Membrane Endothelial Keratoplasty (DMEK)

Descemets Membrane Endothelial Keratoplasty(DMEK)

Charles S. Ahn, MDMedical Director

Dupage Medical Group Eye Specialists

1

CornealAnatomy

ALK Superficial

DALK

PK

PLK=DLEK

DSLEK

DSAEK

PKvs.DSAEK

DSAEK

VisualRecoveryTime

12 Months

6 Months

5 Months

1Month

Treatment of Endothelial Disease

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Penetrating Keratoplasty

Endothelial KeratoplastyPosterior Lamellar Keratoplasty (PLK)Descemets Stripping Automated Endothelial

Keratoplasty (DSEK/DSAEK)Descemets Membrane Endothelial Keratoplasty

(DMEK)

SELECTIVEREPLACEMENTOFDISEASEDORDAMAGEDPOSTERIOR

LAYERSOFTHECORNEA12

DSAEKProcedure

3 Major Challenges with DSAEK

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Visual AcuitySuboptimalVisual rehabilitation is relatively slow

Accessibility to tissueInvestment in equipmentPurchase of predissected tissue

Drop in donor endothelial cell density in the early postoperative phase

Who Moved My Cheese?

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History of DMEK

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2002, Melles et al published a possible technique for transplanting DM and endothelium.

2006, Melles published a case of a patient achieving 20/20 vision at week 1 with DMEK.

2007, Art Giebel presented the SCUBA technique at AAO for harvesting the graft

2009, Francis Price presented results of DMEK indicating they may be superior to DSAEK

Potential Advantages of DMEK

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Great Visual Results

Quick Recovery

Use of inexpensive techniques

Increased availability

Decrease crowding of the anterior chamber (i.e. tube shunt)

Challenges with DMEK

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New skills and techniques

Successful and reliable harvesting of the donor graft

Intraocular placement and positioning of the graft

Postoperative management successful attachment of the graft

Harvesting the Graft

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SCUBA techniqueArt GiebelSubmerged Cornea Using Backgrounds AwayAddresses :

HandlingVisualization (Red Reflex)

Viewing Chamber for Donor GraftBarron Donor Punch

Trypan Blue

Use a trephine

Implanting the Donor Membrane

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Insertion of the membraneStaar injector

OrientationDead Sea Scrolls

UnwrappingBSS with a cannulaAir

Positioning

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27

28

29

30

31

32

33

34

35

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1DayDMEKPostop

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DMEKPostop

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EdgeofDMEKGraft

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EdgeInterface

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DSAEKGraft

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PartialDetachmentwithDMEK

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DSAEKVisante OCT

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Conclusions

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DMEK appears to be an effective method in managing corneal endothelial disorders providing quick and excellent visual rehabilitation.

Need more long-term follow-up and data.

Need improved techniques in handling, positioning, and attaching graft.

g{t~ l

Charles S. Ahn, MDMedical Director

Dupage Medical Group Eye Specialists

45

Prechopping Technique

Prechopping Technique

Prechopping Technique

Prechopping Technique

Prechopping Technique

Prechopping Technique

Prechopping Technique

Prechopping Technique

HybridPrechopper Closed

Prechopping Video

Prechopping Video2