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    Three reasons for adopting DMEK in routine EK cases

    Improved visual results, lower rejection rate, less steroid-induced glaucoma among benefits

     

    When not to use DMEK

    DSAEK is still needed for eyes with a prior vitrectomy, for tubes and traps, ACIOL, ICE and aniridia, and aphakia. DMEK can be used in those first two categories, but it is much more difficult and should probably be avoided, especially by a surgeon new to using DMEK.

    The transition from DSAEK to DMEK is an additive transformation, not an exclusionary one, Dr. Terry commented.

    DMEK can be done for all routine cases of endothelial replacement; DSAEK can be used for complex, high-morbidity cases, and PK is still needed for cases that need transplant for full-thickness disease.

     


    References

    1. Busin M, Madi S, Santorum P, Scorcia V, Beltz J. Ultrathin descemet’s stripping automated endothelial keratoplasty with the microkeratome double-pass technique: two-year outcomes. Ophthalmology. 2013;120:1186-1194.
    2. 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;122:2193-2199. doi: 10.1016/j.ophtha.2015.07.003. Epub 2015 Aug 11.
    3. Phillips PM1, Phillips LJ, Muthappan V, Maloney CM, Carver CN. An experienced DSAEK surgeon’s transition to DMEK: Outcomes comparing the last one hundred DSAEK surgeries with the first one hundred DMEK surgeries exclusively using previously published techniques. Cornea. 2017;36:275-279.
    4. Dapena I, Moutsouris K, Droutsas K, Ham L, van Dijk K, Melles GR. Standardized “no-touch” technique for Descemet membrane endothelial keratoplasty. Arch Ophthalmol. 2011;129:88-94. doi: 10.1001/archophthalmol.2010.334.
    5. 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;116:2361-8. doi: 10.1016/j.ophtha.2009.07.010. Epub 2009 Oct 28.
    6. Kruse FE, Laaser K, Cursiefen C, Heindl LM, Schlötzer-Schrehardt U, Riss S, Bachmann BO. A stepwise approach to donor preparation and insertion increases safety and outcome of Descemet membrane endothelial keratoplasty. Cornea. 2011;30:580-587.
    7. Terry MA, Straiko MD, Veldman PB, Talajic JC, VanZyl C, Sales CS, Mayko ZM. Standardized DMEK Technique: Reducing complications using prestripped tissue, novel glass injector, and sulfur hexafluoride (SF6) gas. Cornea. 2015;34:845-852. doi: 10.1097/ICO.0000000000000479.
    8. Yoeruek E, Bayyoud T, Hofmann J, Bartz-Schmidt KU. Novel maneuver facilitating Descemet membrane unfolding in the anterior chamber. Cornea. 2013;32:370-373.
    9. Güell JL1, Morral M, Gris O, Elies D, Manero F. Bimanual technique for insertion and positioning of endothelium-Descemet membrane graft in Descemet membrane endothelial keratoplasty. Cornea. 2013;32:1521-1526.

     

     

     

    Mark A. Terry, MD
    P: 503/413-8202     E: [email protected]
    This article was adapted from Dr. Terry’s presentation during Cornea Subspecialty Day at the 2016 meeting of the American Academy of Ophthalmology. Dr. Terry has received grant support from Bausch + Lomb and Moria.

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