DMEK Surgery

Less than a decade ago, corneal transplantation took a big leap forward with the introduction of Descemet’s stripping endothelial keratoplasty (DSEK), which removes only Descemet’s membrane and the diseased endothelium and replaces them with a thin, tripartite donor graft of posterior corneal stroma, Descemet’s membrane, and healthy endothelium. Then came DSAEK, in which the donor graft is prepared with an automated microkeratome, allowing for easier donor preparation and reproducible results by surgeons and eye bank technicians.1 DSAEK has proved to have many advantages over penetrating keratoplasty (PK) and its endothelial predecessors (see “A Brief History of Endothelial Keratoplasty”). Now DSAEK is being compared with a newer technique, Descemet’s membrane endothelial keratoplasty (DMEK), which has emerged as a promising alternative—grafting only Descemet’s membrane and endothelium, allowing for a pure anatomical replacement of only what was removed and the possibility of even better vision with quicker healing.1 Although indications for these procedures are similar, each has unique benefits and drawbacks. Five cornea surgeons offer their perspectives on the procedures and their thoughts on whether it may be time to move to the newer surgery.