How to Perform Descemet's Membrane Endothelial Keratoplasty: A Step by Step Guide
Journal of Ophthalmic and Optometric Sciences,
Vol. 6 No. 3 (2022),
14 November 2023
,
Page 37-51
https://doi.org/10.22037/joos.v6i3.43895
Abstract
Descemet's Membrane Endothelial Keratoplasty (DMEK) is a type of lamellar (partial thickness) corneal transplantation in which the endothelium, along with Descemet's membrane, is transferred. This technique has gained increased popularity in recent years and is expected to become more prominent and widely used among the various types of corneal transplantation. This review article provides a step-by-step guide for corneal surgeons on conducting DMEK. Like any other surgical procedure, gaining experience and completing consecutive surgeries can improve the delicate and precise execution of this procedure. Watching videos, observing live surgeries performed by experienced surgeons who have sufficient expertise in this procedure, and ultimately performing the surgery under the guidance of experienced individuals are factors that contribute to better surgical outcomes. This text serves solely as a guide for performing the continuous stages of DMEK.
- Descemet's Membrane
- Endothelial
- Keratoplasty
- Guide
- 2022-06-22 (2)
- 2023-11-14 (1)
How to Cite
References
Melles GR, Ong TS, Ververs B, van der Wees J. Descemet membrane endothelial keratoplasty (DMEK). Cornea. 2006;25(8):987-90.
Kemer ÖE, Karaca EE, Oellerich S, Melles G. Evolving Techniques and Indications of Descemet Membrane Endothelial Keratoplasty. Turk J Ophthalmol. 2021;51(6):381-92.
Liu M, Hong J. Risk Factors for Endothelial Decompensation after Penetrating Keratoplasty and Its Novel Therapeutic Strategies. J Ophthalmol. 2018;2018:1389486.
Hooton J, Kim KH, Lentz SI, Hicks N, Jones K, McCoy K, et al. Safety of Long-Term Storage and Shipping of Prestripped, Prestained, and Preloaded Descemet Membrane Endothelial Keratoplasty Tissue. Cornea. 2019;38(8):1023-8. .
Vasquez Perez A, Liu C. Human Ex Vivo Artificial Anterior Chamber Model for Practice DMEK Surgery. Cornea. 2017;36(3):394-7.
Price MO, Giebel AW, Fairchild KM, Price FW Jr. Descemet's membrane endothelial keratoplasty: prospective multicenter study of visual and refractive outcomes and endothelial survival. Ophthalmology. 2009;116(12):2361-8.
Price FW Jr, Price MO. Descemet's stripping with endothelial keratoplasty in 50 eyes: a refractive neutral corneal transplant. J Refract Surg. 2005;21(4):339-45.
Trindade BLC, Eliazar GC. Descemet membrane endothelial keratoplasty (DMEK): an update on safety, efficacy and patient selection. Clin Ophthalmol. 2019;13:1549-57.
Gorovoy MS. Descemet-stripping automated endothelial keratoplasty. Cornea. 2006;25(8):886-9.
Pilger D, Maier AK, Bertelmann E, Joussen A, Torun N. Use of topical anaesthesia and peribulbar anaesthesia in Descemets membrane endothelial keratoplasty. Eur J Ophthalmol. 2021;31(3):1431-6.
Rickmann A, Andres C, Boden K, Wahl S, Szurman P. Analysis of different types of anesthesia in descemet membrane endothelial keratoplasty. Int Ophthalmol. 2020;40(3):541-5.
Greiner MA, Rixen JJ, Wagoner MD, Schmidt GA, Stoeger CG, Straiko MD, et al. Diabetes mellitus increases risk of unsuccessful graft preparation in Descemet membrane endothelial keratoplasty: a multicenter study. Cornea. 2014;33(11):1129-33.
Sahay P, Fogla R, Sharma N. Preferred practice pattern for Descemet membrane endothelial keratoplasty surgeries: A survey of Indian corneal surgeons. Indian J Ophthalmol. 2022;70(8):2956-61.
Heinzelmann S, Hüther S, Böhringer D, Eberwein P, Reinhard T, Maier P. Influence of donor characteristics on descemet membrane endothelial keratoplasty. Cornea. 2014;33(6):644-8.
Maier AK, Gundlach E, Schroeter J, Klamann MK, Gonnermann J, Riechardt AI, et al. Influence of the difficulty of graft unfolding and attachment on the outcome in Descemet membrane endothelial keratoplasty. Graefes Arch Clin Exp Ophthalmol. 2015;253(6):895-900.
Schaub F, Collmer M, Schrittenlocher S, Bachmann BO, Cursiefen C, Hos D. Outcome of Descemet Membrane Endothelial Keratoplasty Using Corneas from Donors ≥80 Years of Age. Am J Ophthalmol. 2020;211:200-6.
Basak SK, Basak S, Gajendragadkar N. Outcomes of Descemet Membrane Endothelial Keratoplasty Using Cornea From Elderly Donors Aged 80 Years and Older: In the Aftermath of Current Donor Shortage. Cornea. 2022;41(11):1437-43.
Terry MA, Straiko MD, Veldman PB, Talajic JC, VanZyl C, Sales CS, et al. Standardized DMEK Technique: Reducing Complications Using Prestripped Tissue, Novel Glass Injector, and Sulfur Hexafluoride (SF6) Gas. Cornea. 2015;34(8):845-52.
Busin M, Leon P, D'Angelo S, Ruzza A, Ferrari S, Ponzin D, et al. Clinical Outcomes of Preloaded Descemet Membrane Endothelial Keratoplasty Grafts With Endothelium Tri-Folded Inwards. Am J Ophthalmol. 2018;193:106-13.
Chen SY, Terry MA. Step-by-step Descemet's membrane endothelial keratoplasty surgery. Taiwan J Ophthalmol. 2019;9(1):18-26.
Shen E, Fox A, Johnson B, Farid M. Comparing the effect of three Descemet membrane endothelial keratoplasty injectors on endothelial damage of grafts. Indian J Ophthalmol. 2020;68(6):1040-3.
Downes K, Tran KD, Stoeger CG, Chamberlain W. Cumulative Endothelial Cell Loss in Descemet Membrane Endothelial Keratoplasty Grafts From Preparation Through Insertion With Glass Injectors. Cornea. 2018;37(6):698-704.
Kim EC, Bonfadini G, Todd L, Zhu A, Jun AS. Simple, inexpensive, and effective injector for descemet membrane endothelial keratoplasty. Cornea. 2014;33(6):649-52.
Kruse FE, Laaser K, Cursiefen C, Heindl LM, Schlötzer-Schrehardt U, Riss S, et al. A stepwise approach to donor preparation and insertion increases safety and outcome of Descemet membrane endothelial keratoplasty. Cornea. 2011;30(5):580-7.
Gorovoy IR, Gorovoy MS. Descemet membrane endothelial keratoplasty postoperative year 1 endothelial cell counts. Am J Ophthalmol. 2015;159(3):597-600.
Price MO, Price FW Jr. Descemet's membrane endothelial keratoplasty surgery: update on the evidence and hurdles to acceptance. Curr Opin Ophthalmol. 2013;24(4):329-35.
Hamzaoglu EC, Straiko MD, Mayko ZM, Sáles CS, Terry MA. The First 100 Eyes of Standardized Descemet Stripping Automated Endothelial Keratoplasty versus Standardized Descemet Membrane Endothelial Keratoplasty. Ophthalmology. 2015;122(11):2193-9.
Melles GR, Wijdh RH, Nieuwendaal CP. A technique to excise the descemet membrane from a recipient cornea (descemetorhexis). Cornea. 2004;23(3):286-8.
Borroni D, Rocha de Lossada C, Parekh M, Gadhvi K, Bonzano C, Romano V, et al. Tips, Tricks, and Guides in Descemet Membrane Endothelial Keratoplasty Learning Curve. J Ophthalmol. 2021;2021:1819454.
Godinho JV, Mian SI. Update on Descemet membrane endothelial keratoplasty. Curr Opin Ophthalmol. 2019;30(4):271-4.
Agarwal M, Dutta Majumder P, Babu K, Konana VK, Goyal M, Touhami S, et al. Drug-induced uveitis: A review. Indian J Ophthalmol. 2020;68(9):1799-1807.
Crews JW, Price MO, Lautert J, Feng MT, Price FW Jr. Intraoperative hyphema in Descemet membrane endothelial keratoplasty alone or combined with phacoemulsification. J Cataract Refract Surg. 2018;44(2):198-201.
Ong HS, Htoon HM, Ang M, Mehta JS. "Endothelium-Out" and "Endothelium-In" Descemet Membrane Endothelial Keratoplasty (DMEK) Graft Insertion Techniques: A Systematic Review With Meta-Analysis. Front Med (Lausanne). 2022;9:868533.
Tourtas T, Schlomberg J, Wessel JM, Bachmann BO, Schlötzer-Schrehardt U, Kruse FE. Graft adhesion in descemet membrane endothelial keratoplasty dependent on size of removal of host's descemet membrane. JAMA Ophthalmol. 2014;132(2):155-61.
Mehta JS, Hantera MM, Tan DT. Modified air-assisted descemetorhexis for Descemet-stripping automated endothelial keratoplasty. J Cataract Refract Surg. 2008;34(6):889-91.
Kruse FE, Schrehardt US, Tourtas T. Optimizing outcomes with Descemet's membrane endothelial keratoplasty. Curr Opin Ophthalmol. 2014;25(4):325-34.
Tausif HN, Johnson L, Titus M, Mavin K, Chandrasekaran N, Woodward MA, et al. Corneal donor tissue preparation for Descemet's membrane endothelial keratoplasty. J Vis Exp. 2014;(91):51919.
Lie JT, Birbal R, Ham L, van der Wees J, Melles GR. Donor tissue preparation for Descemet membrane endothelial keratoplasty. J Cataract Refract Surg. 2008;34(9):1578-83.
Fogla R, Thazethaeveetil IR. A Novel Technique for Donor Insertion and Unfolding in Descemet Membrane Endothelial Keratoplasty. Cornea. 2021;40(8):1073-8.
Zhu Z, Rife L, Yiu S, Trousdale MD, Wasilewski D, Siqueira A, et al. Technique for preparation of the corneal endothelium-Descemet membrane complex for transplantation. Cornea. 2006;25(6):705-8.
Majmudar PA, Johnson L. Enhancing DMEK Success by Identifying Optimal Levels of Trypan Blue Dye Application to Donor Corneal Tissue. Cornea. 2017;36(2):217-21.
Ignacio TS, Nguyen TT, Sarayba MA, Sweet PM, Piovanetti O, Chuck RS, et al. A technique to harvest Descemet's membrane with viable endothelial cells for selective transplantation. Am J Ophthalmol. 2005;139(2):325-30.
Veldman PB, Dye PK, Holiman JD, Mayko ZM, Sáles CS, Straiko MD, et al. The S-stamp in Descemet Membrane Endothelial Keratoplasty Safely Eliminates Upside-down Graft Implantation. Ophthalmology. 2016;123(1):161-4.
Veldman PB, Dye PK, Holiman JD, Mayko ZM, Sáles CS, Straiko MD, et al. Stamping an S on DMEK Donor Tissue to Prevent Upside-Down Grafts: Laboratory Validation and Detailed Preparation Technique Description. Cornea. 2015;34(9):1175-8.
Birbal RS, Sikder S, Lie JT, Groeneveld-van Beek EA, Oellerich S, Melles GRJ. Donor Tissue Preparation for Descemet Membrane Endothelial Keratoplasty: An Updated Review. Cornea. 2018;37(1):128-35.
Lohmann T, Baumgarten S, Plange N, Walter P, Fuest M. Effects of uncomplicated Descemet membrane endothelial keratoplasty on the central retinal thickness. Graefes Arch Clin Exp Ophthalmol. 2021;259(9):2731-41.
Dapena I, Ham L, Droutsas K, van Dijk K, Moutsouris K, Melles GR. Learning Curve in Descemet's Membrane Endothelial Keratoplasty: First Series of 135 Consecutive Cases. Ophthalmology. 2011;118(11):2147-54.
Marques RE, Guerra PS, Sousa DC, Gonçalves AI, Quintas AM, Rodrigues W. DMEK versus DSAEK for Fuchs' endothelial dystrophy: A meta-analysis. Eur J Ophthalmol. 2019;29(1):15-22.
Feng MT, Price MO, Price FW Jr. Update on Descemet membrane endothelial keratoplasty (DMEK). Int Ophthalmol Clin. 2013 Spring;53(2):31-45.
Onouchi H, Hayashi T, Shimizu T, Matsuzawa A, Suzuki Y, Kato N. Anatomical Changes in the Anterior Chamber Volume After Descemet Membrane Endothelial Keratoplasty. Cornea. 2021;40(6):690-5.
Siddiqui A, Chamberlain WD. Descemet membrane endothelial keratoplasty in complex eyes. Curr Opin Ophthalmol. 2022;33(4):324-31.
Sorkin N, Einan-Lifshitz A, Ashkenazy Z, Boutin T, Showail M, Borovik A, et al. Enhancing Descemet Membrane Endothelial Keratoplasty in Postvitrectomy Eyes With the Use of Pars Plana Infusion. Cornea. 2017 Mar;36(3):280-3.
Burkhart ZN, Feng MT, Price MO, Price FW. Handheld slit beam techniques to facilitate DMEK and DALK. Cornea. 2013;32(5):722-4.
Jacob S, Agarwal A, Agarwal A, Narasimhan S, Kumar DA, Sivagnanam S. Endoilluminator-assisted transcorneal illumination for Descemet membrane endothelial keratoplasty: enhanced intraoperative visualization of the graft in corneal decompensation secondary to pseudophakic bullous keratopathy. J Cataract Refract Surg. 2014;40(8):1332-6.
Cost B, Goshe JM, Srivastava S, Ehlers JP. Intraoperative optical coherence tomography-assisted descemet membrane endothelial keratoplasty in the DISCOVER study. Am J Ophthalmol. 2015;160(3):430-7.
Steven P, Le Blanc C, Velten K, Lankenau E, Krug M, Oelckers S, et al. Optimizing descemet membrane endothelial keratoplasty using intraoperative optical coherence tomography. JAMA Ophthalmol. 2013;131(9):1135-42.
Yoeruek E, Bayyoud T, Hofmann J, Bartz-Schmidt KU. Novel maneuver facilitating Descemet membrane unfolding in the anterior chamber. Cornea. 2013;32(3):370-3.
Liarakos VS, Dapena I, Ham L, van Dijk K, Melles GR. Intraocular graft unfolding techniques in descemet membrane endothelial keratoplasty. JAMA Ophthalmol. 2013;131(1):29-35.
Gonzalez A, Price FW Jr, Price MO, Feng MT. Prevention and Management of Pupil Block After Descemet Membrane Endothelial Keratoplasty. Cornea. 2016;35(11):1391-5.
Suh LH, Yoo SH, Deobhakta A, Donaldson KE, Alfonso EC, Culbertson WW, et al. Complications of Descemet's stripping with automated endothelial keratoplasty: survey of 118 eyes at One Institute. Ophthalmology. 2008;115(9):1517-24.
Terry MA, Shamie N, Chen ES, Hoar KL, Friend DJ. Endothelial keratoplasty a simplified technique to minimize graft dislocation, iatrogenic graft failure, and pupillary block. Ophthalmology. 2008;115(7):1179-86.
Kladny AS, Zander DB, Lieberum JL, Glatz A, Brandi-Dohrn F, Reinhard T, et al. Graft Detachment after Descemet Membrane Endothelial Keratoplasty with and without Cataract Surgery. Ophthalmol Sci. 2022 8;2(4):100194.
Parekh M, Leon P, Ruzza A, Borroni D, Ferrari S, Ponzin D, et al. Graft detachment and rebubbling rate in Descemet membrane endothelial keratoplasty. Surv Ophthalmol. 2018;63(2):245-50.
von Marchtaler PV, Weller JM, Kruse FE, Tourtas T. Air Versus Sulfur Hexafluoride Gas Tamponade in Descemet Membrane Endothelial Keratoplasty: A Fellow Eye Comparison. Cornea. 2018;37(1):15-19.
Ćirković A, Beck C, Weller JM, Kruse FE, Tourtas T. Anterior Chamber Air Bubble to Achieve Graft Attachment After DMEK: Is Bigger Always Better? Cornea. 2016;35(4):482-5.
Saethre M, Drolsum L. The role of postoperative positioning after DSAEK in preventing graft dislocation. Acta Ophthalmol. 2014;92(1):77-81.
Safir M, Dubinsky-Pertzov B, Peled A, Rozenberg A, Zadok D, et al. Postoperative supine position after primary Descemet-stripping automated endothelial keratoplasty reduces graft detachment rate. Can J Ophthalmol. 2022;57(3):147-53.
- Abstract Viewed: 116 times
- pdf Downloaded: 71 times
