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Descemet Membrane Endothelial Keratoplasty (DMEK) Surgery with a Standardized Technique

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Mastering Endothelial Keratoplasty

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Abstract

The goal of this chapter is to provide the DMEK surgeon with a toolkit of techniques to prevent and manage perioperative complications by unpacking the procedure step by step. The chapter is organized into preoperative and intraoperative considerations. Specific techniques for unscrolling the graft, because there are so many, are not reviewed in great detail, either. A summary table is provided for quick reference (Table 9.1). A video tutorial is also available and is indispensable to mastering the concepts set forth in this chapter.

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References

  1. Yoeruek E, Bayyoud T, Hofmann J, Bartz-Schmidt KU. Novel maneuver facilitating Descemet membrane unfolding in the anterior chamber. Cornea. 2013;32:370–3.

    Article  PubMed  Google Scholar 

  2. Dapena I, Moutsouris K, Droutsas K, et al. Standardized “no-touch” technique for descemet membrane endothelial keratoplasty. Arch Ophthalmol. 2011;129:88–94.

    Article  PubMed  Google Scholar 

  3. Aldave AJ, Chen JL, Zaman AS, et al. Outcomes after DSEK in 101 eyes with previous trabeculectomy and tube shunt implantation. Cornea. 2014;33:223–9.

    Article  PubMed  Google Scholar 

  4. Phillips PM, Terry MA, Shamie N, et al. Descemet stripping automated endothelial keratoplasty in eyes with previous trabeculectomy and tube shunt procedures: intraoperative and early postoperative complications. Cornea. 2010;29:534–40.

    Article  PubMed  Google Scholar 

  5. Bersudsky V, Trevino A, Rumelt S. Management of endothelial decompensation because of glaucoma shunt tube touch by descemet membrane endothelial keratoplasty and tube revision. Cornea. 2011;30:709–11.

    Article  PubMed  Google Scholar 

  6. Heindl LM, Koch KR, Bucher F, et al. Descemet membrane endothelial keratoplasty in eyes with glaucoma implants. Optom Vis Sci. 2013;90:e241–4; discussion 1029.

    Article  PubMed  Google Scholar 

  7. Price MO, Price Jr FW. Descemet stripping with endothelial keratoplasty for treatment of iridocorneal endothelial syndrome. Cornea. 2007;26:493–7.

    Article  PubMed  Google Scholar 

  8. Liarakos VS, Ham L, Dapena I, et al. Endothelial keratoplasty for bullous keratopathy in eyes with an anterior chamber intraocular lens. J Cataract Refract Surg. 2013;39:1835–45.

    Article  PubMed  Google Scholar 

  9. Heinzelmann S, Huther S, Bohringer D, et al. Influence of donor characteristics on descemet membrane endothelial keratoplasty. Cornea. 2014;33:644–8.

    Article  PubMed  Google Scholar 

  10. Tourtas T, Schlomberg J, Wessel JM, et al. Graft adhesion in descemet membrane endothelial keratoplasty dependent on size of removal of Host’s descemet membrane. JAMA Ophthalmol. 2014;132:155–61.

    Article  PubMed  Google Scholar 

  11. Terry MA, Straiko MD, Veldman PB, Talajic JC, VanZyl C, Sales CS, Mayko ZM. Standardized DMEK technique: reducing complications using prestripped tissue, novel glass injector, and sulfur hexafluoride (SF6) gas. Cornea. 2015;34:845–52.

    Google Scholar 

  12. Ciechanowski PP, Droutsas K, Baydoun L, et al. Standardized descemet membrane endothelial keratoplasty (DMEK): technique and latest results. Ophthalmologe. 2014;111(11):1041–9.

    Article  CAS  PubMed  Google Scholar 

  13. Gorovoy MS. DMEK complications. Cornea. 2014;33:101–4.

    Article  PubMed  Google Scholar 

  14. Monnereau C, Quilendrino R, Dapena I, et al. Multicenter study of descemet membrane endothelial keratoplasty: first case series of 18 surgeons. JAMA Ophthalmol. 2014.

    Google Scholar 

  15. Parker J, Dirisamer M, Naveiras M, et al. Outcomes of descemet membrane endothelial keratoplasty in phakic eyes. J Cataract Refract Surg. 2012;38:871–7.

    Article  PubMed  Google Scholar 

  16. Terry MA, Shamie N, Chen ES, et al. Endothelial keratoplasty for Fuchs’ dystrophy with cataract: complications and clinical results with the new triple procedure. Ophthalmology. 2009;116:631–9.

    Article  PubMed  Google Scholar 

  17. Gorovoy IR, Cui QN, Gorovoy MS. Donor tissue characteristics in preparation of DMEK grafts. Cornea. 2014;33:683–5.

    Article  PubMed  Google Scholar 

  18. Feng MT, Burkhart ZN, Price Jr FW, Price MO. Effect of donor preparation-to-use times on descemet membrane endothelial keratoplasty outcomes. Cornea. 2013;32:1080–2.

    Article  PubMed  Google Scholar 

  19. Tenkman LR, Price FW, Price MO. Descemet membrane endothelial keratoplasty donor preparation: navigating challenges and improving efficiency. Cornea. 2014;33:319–25.

    Article  PubMed  Google Scholar 

  20. Schloetzer-Schrehardt U, Bachmann BO, Tourtas T, et al. Reproducibility of graft preparations in Descemet’s membrane endothelial keratoplasty. Ophthalmology. 2013;120:1769–77.

    Article  Google Scholar 

  21. Groeneveld-van Beek EA, Lie JT, van der Wees J, et al. Standardized “no-touch” donor tissue preparation for DALK and DMEK: harvesting undamaged anterior and posterior transplants from the same donor cornea. Acta Ophthalmol. 2013;91:145–50.

    Article  CAS  PubMed  Google Scholar 

  22. Lie JT, Birbal R, Ham L, et al. Donor tissue preparation for Descemet membrane endothelial keratoplasty. J Cataract Refract Surg. 2008;34:1578–83.

    Article  PubMed  Google Scholar 

  23. Kruse FE, Laaser K, Cursiefen C, et al. A stepwise approach to donor preparation and insertion increases safety and outcome of Descemet membrane endothelial keratoplasty. Cornea. 2011;30:580–7.

    PubMed  Google Scholar 

  24. Price MO, Giebel AW, Fairchild KM, Price Jr FW. Descemet’s membrane endothelial keratoplasty prospective multicenter study of visual and refractive outcomes and endothelial survival. Ophthalmology. 2009;116:2361–8.

    Article  PubMed  Google Scholar 

  25. Guell JL, Morral M, Gris O, et al. Bimanual technique for insertion and positioning of endothelium-Descemet membrane graft in Descemet membrane endothelial keratoplasty. Cornea. 2013;32:1521–6.

    Article  PubMed  Google Scholar 

  26. Kruse FE, Schrehardt US, Tourtas T. Optimizing outcomes with Descemet’s membrane endothelial keratoplasty. Curr Opin Ophthalmol. 2014;25:325–34.

    Article  PubMed  Google Scholar 

  27. Liarakos VS, Dapena I, Ham L, et al. Intraocular graft unfolding techniques in descemet membrane endothelial keratoplasty. JAMA Ophthalmol. 2013;131:29–35.

    Article  PubMed  Google Scholar 

  28. Burkhart ZN, Feng MT, Price MO, Price FW. Handheld slit beam techniques to facilitate DMEK and DALK. Cornea. 2013;32:722–4.

    Article  PubMed  Google Scholar 

  29. Steven P, Le Blanc C, Velten K, et al. Optimizing descemet membrane endothelial keratoplasty using intraoperative optical coherence tomography. JAMA Ophthalmol. 2013;131:1135–42.

    Article  PubMed  Google Scholar 

  30. Jacob S, Agarwal A, Agarwal A, et al. Endoilluminator-assisted transcorneal illumination for Descemet membrane endothelial keratoplasty: enhanced intraoperative visualization of the graft in corneal decompensation secondary to pseudophakic bullous keratopathy. J Cataract Refract Surg. 2014;40(8):1332–6.

    Article  PubMed  Google Scholar 

  31. Bachmann BO, Laaser K, Cursiefen C, Kruse FE. A method to confirm correct orientation of descemet membrane during descemet membrane endothelial keratoplasty. Am J Ophthalmol. 2010;149:922–5 e2.

    Article  PubMed  Google Scholar 

  32. Acar BT, Muftuoglu O, Acar S. Comparison of sulfur hexafluoride and air for donor attachment in Descemet stripping endothelial keratoplasty in patients with pseudophakic bullous keratopathy. Cornea. 2014;33:219–22.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Weill Cornell Medicine, 1305 York Avenue, New York, NY, 10021, USA

    Christopher S. Sáles MD, MPH

  2. Lions VisionGift, 2201 SE 11th Avenue, Portland, OR, 97214-5303, USA

    Zachary M. Mayko MS

  3. Devers Eye Institute, 1040 NW 22nd Ave #200, Portland, OR, 97210, USA

    Mark A. Terry MD & Michael D. Straiko MD

Authors
  1. Christopher S. Sáles MD, MPH
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  2. Zachary M. Mayko MS
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  3. Mark A. Terry MD
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  4. Michael D. Straiko MD
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Corresponding author

Correspondence to Michael D. Straiko MD .

Editor information

Editors and Affiliations

  1. Director and Chief, Dr. Agarwal's Refractive and Cornea Foundation, Dr. Agarwal's Group of Eye Hospitals , Chennai, India

    Soosan Jacob

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Sáles, C.S., Mayko, Z.M., Terry, M.A., Straiko, M.D. (2016). Descemet Membrane Endothelial Keratoplasty (DMEK) Surgery with a Standardized Technique. In: Jacob, S. (eds) Mastering Endothelial Keratoplasty. Springer, New Delhi. https://doi.org/10.1007/978-81-322-2818-9_9

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  • DOI: https://doi.org/10.1007/978-81-322-2818-9_9

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  • Publisher Name: Springer, New Delhi

  • Print ISBN: 978-81-322-2816-5

  • Online ISBN: 978-81-322-2818-9

  • eBook Packages: MedicineMedicine (R0)

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