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  • Existing evidence suggests DMEK is safe, effective for endothelial failure

    Cornea/External Disease

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    This assessment by the Ophthalmic Technology Assessment Committee of the Academy’s Cornea and Anterior Segment Disorders Panel reviews the safety and outcomes of Descemet membrane endothelial keratoplasty (DMEK) to treat corneal endothelial dysfunction.

    Study design

    The authors reviewed the abstracts of 1,085 articles from the PubMed and Cochrane Library Literature databases, and selected 47 large (>25 DMEK cases), prospective, controlled clinical studies; and observational studies for inclusion in the final assessment. Of the 47 studies, the panel’s methodologist rated 2 as level I evidence, 15 as level II evidence and 30 as level III evidence.

    Key search terms included Descemet membrane endothelial keratoplasty, Descemet's membrane endothelial keratoplasty, DMEK, posterior lamellar keratoplasty and endothelial keratoplasty. Studies of nonhuman and deep anterior lamellar keratoplasty were excluded.

    Outcomes

    By 6 months after DMEK surgery, up to 85% of eyes achieved a BCVA of 20/25 or better and up to 67% achieved a BCVA of 20/20 or better. Each study showed a rapid visual recovery after successful DMEK, with final mean BCVA ranging from 20/21 to 20/31.

    The most common complication was partial graft detachment requiring air injection (mean 29%), followed by elevated IOP (range 0-22%), primary graft failure (mean 1.7%), secondary graft failure (mean 2.2%) and immune rejection (mean 1.9%).

    The 7 studies that directly compared the visual outcomes of DMEK and Descemet’s stripping endothelial keratoplasty (DSEK) all showed better visual outcomes after DMEK (6 of these 7 studies were rated as level II evidence). Recovery times, complication and rejection rates also favored DMEK.

    Limitations

    The searches were limited to English-language abstracts, potentially excluding key findings published in other languages.

    Clinical significance

    Evidence from the published literature supports DMEK as a safe and effective treatment for endothelial failure. Regarding recovery time, visual outcomes, and complication and rejection rates, DMEK seems to be superior to DSEK.