Descemet's membrane endothelial keratoplasty(DMEK), while potentially optimizing visual outcome and postoperative recovery speed, has not gained widespread popularity in part because of the difficulty of harvesting, handling, and delivering the donor tissue.
To address this issue, the authors of this study have developed a procedure incorporating the advantages of Descemet's stripping endothelial keratoplasty (DSAEK) with the optimal optics of DMEK with pneumatic dissection.
They describe how a donor graft consisting of endothelium together with a peripheral "sickle" of deep stroma can be prepared from tissue obtained through pneumatic dissection. Because the central portion of this type of graft does not include any stromal tissue, the optimal optics of DMEK is maintained while incorporating all the advantages of DSAEK surgery. The authors show the procedure in a video clip embedded in the study.
After using this new technique in 10 patients with Fuchs' endothelial dystrophy, the authors conclude that it is quick, preparation of donor tissue is simplified and that tissue handling and insertion is similar to that of DSAEK.
Surgical time was one hour or less in all cases. Although no comparable data exist on operating time for DMEK surgery, in the authors' experience DMEK without stromal support takes at least 1.5 to 2 hours.
Only two cases required re-bubbling owing to early graft detachment, and the final attachment rate was 100 percent. At an average follow-up of 8.4 months, BSCVA was at least 20/40 in all cases, there was no substantial change in refraction, and average endothelial cell loss was 24.1 percent, which is comparable to that reported at six months for conventional DMEK.
The authors conclude that this technique will facilitate uptake of DMEK surgery.