DMEK - first experience LAAC, FOB Tallinn 23Aug2013 ready

DMEK - FIRST EXPERIENCE AT LATVIAN AMERICAN EYE

CENTER

ILZE ŠVEIDUKALAAC

Corneal transplant surgery PKP Lamellar keratoplasty:

-Deep Anterior Lamellar Keratoplasty (DALK);- Endothelial Keratoplasty (EK):o - DLEK (deep lamellar EK)o - DSEK, DSAEK (Descemet’s stripping/automated

EK)o - DMEK.

DMEK D - Descemet M - membrane E - endothelial K – keratpolastyMost delicate endothelial keratoplasty

procedure.NO STROMA!

DMEK surgery steps Donor preparation:

- scoring

- DM peeling (using SCUBA technique)

DMEK surgery steps Donor preparation:

- DM cutting,- staining (TryphaneBlue),- insertion into injector

DMEK surgery steps Recipient preparation:

- anesthesia (retrobulbar)- incisions (three 1.0mm paracentheses, 3.0mm main temporal clear cornea)

DMEK surgery steps Recipient preparation:

- host DM scoring and removal

DMEK surgery steps Membrane graft implantation:

DMEK surgery steps- orienting,- unscrolling,- positioning.

DMEK surgery steps

At the end of surgery anterior chamber is filled with air.

Post-op period Air bubble pressurizes donor DM against

recipient’s stroma. Strict regimen for patient’s horizontal

positioning. Additional air injection (rebubbling) can

be necessary if membrane detaches.

Post-op period

CHIN-UP!

Advantages of DMEK Maintaining structural integrity (sustained

eyeball natural strenght and integrity) Minimal refractive changes Fast visual recovery (weeks) Low risk of rejection (because no stromal

tissue transplanted) No sutures, no suture induced

neovascularization No expensive equipment needed

Disadvantages of DMEK hard to obtain donor material;

hard to position membrane; hard to fix membrane; steep learning curve.

Results of DMEK surgery 21 procedure done at LAAC Dr. Art Giebel – all credits

Results of DMEK surgery Best prognosis:- Phakic or pseudophakic (PC IOL) with

Fuchs’ corneal dystrophy or pseudophakic bullous keratopathy.

Poor prognosis:- Underlying retinal or ON desease,- AC IOL, anterior synechiae.

Case I.Pt. J.R.74 y.o., male.

Dg: OU Artephakia (PC IOL OU). OS Bullous corneal dystrophy.Had cataract surgery about 4 years ago. OS – painful.VA OD 1.0; VA OS 0.01, n.c. B.M. – OS diffuse severe corneal edema, epithelial bullae and

cysts, severe DM folds; pachymetry OS 820micr.DMEK surgery OS.Day 1 post-op. VA OS 0.1 (air bubble 40%).Day 2 post-op. VA OS 0.3 (air bubble 30%).Day 4 post-op. VA OS 0.7 (no air in AC).1 year post-op. UCVA OS 0.5, BCVA OS 1.0 (cc +0.25Dsph/-2.50Dcyl x 95). Pachymetry OS 515micr. 

Case II.Pt. J.Z.71 y.o., female.

Dg: OU Fuchs’ corneal dystrophy. OU Cataracta senilis nuclearis incipiens.

VA OD 0.1, cc+3.25Dsph=0.5; VA OS 0.05, cc+3.25Dsph=0.1. B.M. – OU corneal epithelial microcysts, few bullae,

endothelial …. Pachymetry OD 680micr., OS 710micr.DMEK + cataract surgery OS.Day 1 post-op. VA OS=0.05 (air bubble 40%).Day 3 post-op. VA OS=0.05, cph 0.4 (air bubble 10%).Day 7 post-op. VA OS=0.5; donor DM detached at the edge

nasally; rebubbling.Week 2 post-op. VA OS=0.72 months post-op. UCVA OS=0.9. Pachymetry OS 500micr. 

J.Z. OD Fuchs’

J.Z. OS post DMEK+phaco, IOL; UCVA=0.9

Pt. A.S.; FCD; pre-op BCVA=0.4; post DMEK+cataract surgery BCVA=0.9

DMEK Gaining popularity worldvide Many patients could benefit from DMEK

THANK YOU!