DLEK to DSEK to DMEK

Abstract Purpose: To describe the preliminary clinical results of selective transplantation of organ cultured donor Descemet membrane (DM) carrying autologous corneal endothelium through a 3.5 mm incision, tentatively named Descemet membrane endothelial keratoplasty (DMEK), for the management of corneal endothelial disorders.Design: Non‐randomized clinical trial. Methods: In ten patients with Fuchs’ endothelial dystrophy or pseudophakic bullous keratopathy, DMEK was performed. A 3.5 mm clear corneal tunnel incision was made, the anterior chamber was filled with air, and DM was stripped off from the posterior stroma. A 9.0 mm diameter DM roll was harvested from an organ cultured donor corneo‐scleral rim, and inserted into a recipient anterior chamber. The donor tissue was gently unfolded, positioned onto the posterior stroma, and secured by completely filling the anterior chamber with air for 30 minutes. Results: At one month, six eyes had a best corrected visual acuity of 0.5 (20/40) or better, and three eyes reached 1.0 (20/20) or better. At six months, the endothelial cell density averaged 2030 (± 373) cells/mm2 (n=7). Three eyes showed a complete detachment of the donor tissue in the early postoperative course, that was managed by removal of the transplant and a secondary Descemet stripping endothelial keratoplasty procedure. Conclusions: DMEK may have potential to become the most preferable technique to manage corneal endothelial disorders, because it provides quick and nearly complete visual rehabilitation. Since the donor tissue required can be prepared from organ cultured corneo‐scleral rims, the procedure may be readily accessable to most corneal surgeons.