Dr. Evan Pike, fellowship-trained ophthalmologist and cornea transplant surgeon at Illinois Eye Center, recently completed training on Descemet’s Membrane Endothelial Keratoplasty (DMEK). DMEK is a new surgical procedure that can provide better outcomes for select cornea transplant patients and a lower chance of graft rejection compared to other transplant methods. It is an exciting treatment option for patients with decreased vision and swollen, cloudy corneas seen in Fuchs’ dystrophy, bullous keratopathy, and other causes of poor corneal endothelial function.
There are three generations in the evolution of corneal transplantation, and DMEK is the newest. DMEK has been shown to offer patients the best visual results of available transplant techniques and the ability to quickly resume routine activities with the lowest risk of vision-threatening rejection episodes. When compared to its predecessors, penetrating keratoplasty (PKP) and Descemet’s Stripping Automated Endothelial Keratoplasty (DSAEK), DMEK is the most anatomically correct repair possible – using one cell layer (the endothelial cells) and a thin membrane that is 15 to 20 microns thick.
One of the most challenging aspects of DMEK comes with preparing the donor tissue. The endothelium and attached Descemet’s membrane have to be peeled off of the back of the donor cornea. The DMEK grafts are so ultrathin and fragile that there is a risk of the donor tissue tearing while separating layers. If this happens, it cannot be saved. Preparation, which is provided locally at the Eversight Illinois Eye Bank, is a very careful and delicate process, as the Descemet’s membrane is only 15 microns thick.
DMEK surgery is performed on an outpatient basis. The surgeon removes the diseased innermost layer of the cornea and replaces it with the corresponding thin layer from a healthy donor cornea. The transplant is held in place by an air bubble, requiring patients to lie on their back with their face directed upward immediately following surgery to keep the bubble in place. The bubble gradually leaves within the first week, and as it goes away, patients do not need to lie flat as often. DMEK surgery is performed after cataract surgery for patients in need of both.
For more information on this exciting new procedure, call us at (309) 243-2400.
