A DMEK procedure is the newest procedure offered for corneal endothelial disease. It is a partial-thickness corneal transplant that replaces only the inner layer of cells called the endothelial layer. A thin scroll of donor tissue containing only the endothelial cells is inserted on the back surface of the patient’s cornea. The technique can provide faster and more improved visual outcome over DSAEK.
There are several advantages to DMEK operation compared to standard corneal transplant surgery. The surgery itself takes less time with an experienced surgeon. The wound is smaller, more stable and less likely to break open from trauma. Because the wound is smaller and requires far fewer sutures, there is very little postoperative astigmatism which can delay the visual recovery. The maximum return in vision takes only about 1 to 2 months following DMEK. Since only the endothelial cells of the cornea are replaced, over 95% of the patient’s own cornea remains behind, contributing to greater structural integrity and may reduce the incidence of rejection.
There is a risk of the thin layer of endothelium becoming displaced within the first few days or weeks after surgery and requiring an additional procedure in clinic or possibly a return trip to the operating room to reposition it. If the DMEK operation fails, the operation can be repeated with another button of donor endothelium. If the DMEK fails, either after one or multiple attempts, a DSAEK procedure can be performed.
Only patients with endothelial cell problems are candidates for DMEK. Patients with corneal scarring or other conditions will still require the full-thickness procedure.
I am extremely pleased with this [DMEK corneal transplant] Dr. Weissman has performed. She has been most gracious and professional. Six days later the results are miraculous. Praise the Lord!