DMEK: Surgical Technique

Descemet membrane endothelial keratoplasty (DMEK) has become a standard surgery for endothelial decompensation in Fuchs endothelial corneal dystrophy (FECD) [1]. The indications have been gradually expanded to other situations such as pseudophakic bullous keratopathy [2, 3] or endothelial dysfunction in more complex situations, namely after vitrectomy [4–7], after glaucoma surgery (filtrating surgery or shunt tube surgery) [8], eyes of aphakia or with iris defect [6], or eyes after penetrating keratoplasty (PKP) [9–11]. Almost all patients with blurred vision or glare/photophobia caused by corneal endothelial dysfunction or by corneal guttae in FECD are suitable for DMEK (Fig. 6.1) [12, 13]. An intact iris diaphragm is important for the unfolding process and prevents graft loss into the vitreous. Surgeons who are new to the technique of DMEK should start with such patients and make sure that the anterior chamber (AC) has a normal depth [6, 7, 14]. As there is a certain learning curve to master DMEK, an average of 25 cases are necessary until repeatable results in normal eyes are achieved by otherwise experienced intraocular surgeons [15, 16]. The learning curve might be flattened under the instructions of experienced surgeons (who have experiences of over 100 cases).