DMEK

Simplification and standardization of DMEK – non-contact and gentle handling of the Descemet membrane

Knappschaftsklinikum Saar, Sulzbach, Germany

The revolutionary system for the treatment of endothelial corneal diseases

Corneal transplants are the most frequently performed tissue transplants, which is why clinics are seeing a rapid advancement of modern transplantation techniques, with a tendency to move away from penetrating and increasingly toward lamellar keratoplasty techniques. Since endothelial corneal diseases account for about half of all keratoplasty indications, classic penetrating keratoplasty appears to be rather an overtreatment for this clinical picture, as the transplantation of vital endothelial cells alone would usually be sufficient. For this reason, posterior lamellar techniques, in particular DMEK (Descemet Membrane Endothelial Keratoplasty), have now become well established as a largely atraumatic alternative for the treatment of endothelial corneal diseases. DMEK, for example, is limited to the transplantation of the isolated Descemet membrane with the endothelial cells located on it. The graft no longer contains any stromal components and is characterized by a thickness of only about 15 μm

Clinical advantages of DMEK

The transplantation of the extremely thin Descemet membrane promises a significantly faster visual recovery than other lamellar keratoplasty techniques.

DMEK avoids interface issues, induces no postoperative astigmatism or myopia, and substitutes more endothelial cells with a graft size of up to 9.5 mm. As a result, in many cases a visual acuity improvement to 0.8 or better is achieved within just one week, which has now led to DMEK being established as the gold standard in the treatment of endothelial corneal diseases.

Instruments for the standardization of DMEK

The success of this elegant technique essentially depends on the number of vital endothelial cells and thus on the quality of the sensitive graft and its gentle manipulation. It is crucial that the sensitive cells are never touched or exposed to mechanical stress at any point during preparation or implantation. For a reproducible result, a standardized technique is therefore required for both the preparation and the subsequent implantation, as well as a set of instruments that ensures a non-contact surgical procedure. The Liquid-Bubble technique newly developed in Sulzbach, in which the Descemet membrane is gently separated from the underlying stroma using a liquid, also represents a further step on the path toward the standardization of DMEK. On the following pages we present two preparation sets as well as a surgical set, which allow experienced anterior segment surgeons to use DMEK in their routine.

With these sets, a Descemet membrane can be prepared without contact and implanted safely.

Download our catalog and learn more about DMEK and its accessories.