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Descemet's Membrane Endothelial Keratoplasty (DMEK)

Feb 01, 2017

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  • 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

    11

    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

    19

    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?

    20

  • History of DMEK

    21

    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

    22

    Great Visual Results

    Quick Recovery

    Use of inexpensive techniques

    Increased availability

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

  • Challenges with DMEK

    23

    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

    24

    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

    25

    Insertion of the membraneStaar injector

    OrientationDead Sea Scrolls

    UnwrappingBSS with a cannulaAir

    Positioning

  • 26

  • 27

  • 28

  • 29

  • 30

  • 31

  • 32

  • 33

  • 34

  • 35

  • 36

  • 1DayDMEKPostop

    37

  • DMEKPostop

    38

  • EdgeofDMEKGraft

    39

  • EdgeInterface

    40

  • DSAEKGraft

    41

  • PartialDetachmentwithDMEK

    42

  • DSAEKVisante OCT

    43

  • Conclusions

    44

    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

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