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Descemet’s Membrane Endothelial Keratoplasty (DMEK) Charles S. Ahn, MD Medical Director Dupage Medical Group Eye Specialists 1
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Descemet's Membrane Endothelial Keratoplasty (DMEK)

Feb 01, 2017

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Page 1: Descemet's Membrane Endothelial Keratoplasty (DMEK)

Descemet’s Membrane Endothelial Keratoplasty(DMEK)

Charles S. Ahn, MDMedical Director

Dupage Medical Group Eye Specialists

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Corneal Anatomy

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ALK ‐ Superficial

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DALK

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PK

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PLK = DLEK

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DSLEK

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DSAEK

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PK vs. DSAEK

DSAEK

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Visual Recovery Time

12 Months

6 Months

5 Months

1Month

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Treatment of Endothelial Disease

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•Penetrating Keratoplasty

•Endothelial Keratoplasty•Posterior Lamellar Keratoplasty (PLK)•Descemet’s Stripping Automated Endothelial

Keratoplasty (DSEK/DSAEK)•Descemet’s Membrane Endothelial Keratoplasty

(DMEK)

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“SELECTIVE REPLACEMENT OF DISEASED OR DAMAGED POSTERIOR 

LAYERS OF THE CORNEA”12

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DSAEK Procedure

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3 Major Challenges with DSAEK

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•Visual Acuity•Suboptimal•Visual rehabilitation is relatively slow

•Accessibility to tissue•Investment in equipment•Purchase of predissected tissue

•Drop in donor endothelial cell density in the early postoperative phase

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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

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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)

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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

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Harvesting the Graft

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•SCUBA technique•Art Giebel•Submerged Cornea Using Backgrounds Away•Addresses :

•Handling•Visualization (Red Reflex)

•Viewing Chamber for Donor Graft•Barron Donor Punch

•Trypan Blue

•Use a trephine

Page 25: Descemet's Membrane Endothelial Keratoplasty (DMEK)

Implanting the Donor Membrane

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•Insertion of the membrane•Staar injector

•Orientation•“Dead Sea Scrolls”

•Unwrapping•BSS with a cannula•Air

•Positioning

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1 Day DMEK Postop

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DMEK Postop

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Edge of DMEK Graft

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Edge Interface

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DSAEK Graft

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Partial Detachment with DMEK

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DSAEK Visante 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.

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g{tÇ~ lÉâ

Charles S. Ahn, MDMedical Director

Dupage Medical Group Eye Specialists

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Prechopping Technique

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Prechopping Technique

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Prechopping Technique

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Prechopping Technique

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Prechopping Technique

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Prechopping Technique

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Prechopping Technique

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Prechopping Technique

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Hybrid Prechopper Closed

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Prechopping Video

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Prechopping Video 2