This document provides information on Descemet's membrane endothelial keratoplasty (DMEK), the most delicate type of endothelial keratoplasty. It describes the DMEK surgical procedure, including donor preparation by scoring and peeling the Descemet's membrane, and recipient preparation by scoring and removing the host Descemet's membrane. The document presents two case studies of patients who underwent successful DMEK procedures to treat Fuchs endothelial corneal dystrophy and bullous keratopathy. It notes benefits of DMEK include fast visual recovery, low risk of rejection, and minimal refractive changes. However, it also acknowledges challenges like difficulty obtaining donor material and positioning the membrane. In conclusion, it states many patients could

1. ILZE ŠVEIDUKA
LAAC

2.  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.

3.  D - Descemet
 M - membrane
 E - endothelial
 K – keratpolasty
Most delicate endothelial keratoplasty procedure.
NO STROMA!

4.  Donor preparation:
- scoring
- DM peeling (using SCUBA technique)

5.  Donor preparation:
- DM cutting,
- staining (TryphaneBlue),
- insertion into injector

6.  Recipient preparation:
- anesthesia (retrobulbar)
- incisions (three 1.0mm paracentheses, 3.0mm
main temporal clear cornea)

7.  Recipient preparation:
- host DM scoring and removal

8.  Membrane graft implantation:

9. - orienting,
- unscrolling,
- positioning.

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

11.  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.

12. CHIN-UP!

13.  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

14.  hard to obtain donor material;
 hard to position membrane;
 hard to fix membrane;
 steep learning curve.

15.  21 procedure done at LAAC
 Dr. Art Giebel – all credits

16.  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.

17. 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.

18. 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=0.7
2 months post-op. UCVA OS=0.9. Pachymetry OS 500micr.

19. J.Z. OD Fuchs’
J.Z. OS post DMEK+phaco, IOL; UCVA=0.9

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

21.  Gaining popularity worldvide
 Many patients could benefit from DMEK