DMEK Surgery Cornea Transplant Course – Improving Surgery Results by Sharing Experience

I spent this past Saturday attending a Descemet’s membrane endothelial keratoplasty (DMEK) course at the Sydney Eye Hospital.  Cornea surgeons from across Australia and international guests gathered to share their experience with DMEK and provide tips and tricks to get the best results, reduce complications, and achieve the best visual outcomes for patients. 

The back surface of the cornea, or endothelium, works to pump fluid out of the cornea, keeping it clear and transparent.  If the endothelium is unhealthy or damaged, the pumping mechanism breaks down and fluid can build up within the cornea.  When the cornea swells with more fluid the cornea becomes cloudy and the vision becomes blurry.  In some conditions, such as Fuchs’ dystrophy, the vision can become blurry even prior to fluid building up in the cornea, due to pigmentation of the unhealthy endothelium. 

Surgical treatments for endothelial dysfunction have improved greatly over the last decade.  Full thickness cornea transplants were once considered to be the treatment of choice for these types of cornea problems.  However, this procedure replaces all layers of the cornea when only the back surface layer, or endothelium, is causing the problem.  This procedure is less than ideal as it is replacing more tissue than necessary.  Descemet’s stripping automated endothelial keratoplasty (DSAEK), a partial thickness cornea transplant, is an improvement on the full thickness cornea transplant.  It replaces the Descemet’s membrane/endothelium with a donor Descemet’s membrane/endothelium with some extra stromal tissue.  In the last few years, Descemet’s membrane endothelial keratoplasty (DMEK) has become a popular technique for replacing unhealthy endothelium.  It replaces the Descemet’s membrane/endothelium with a donor Descemet’s membrane/endothelium without any extra stroma tissue.  It yields faster visual recovery compared to DSAEK, a more anatomic correction, and a reduced risk of graft rejection. 

I have worked closely with the Lions Eye Bank technicians at the Royal Victorian Eye and Ear Hospital to prepare DMEK graft tissue for surgeons prior to a scheduled DMEK operation.  This provides less risk of tissue loss and less risk of cancelled operations due to donor tissue problems.  Actively participating in courses like the Sydney DMEK Course, allows surgeons from across Australia and the world to collaborate and share ideas.  Working together and brainstorming ideas will always make progress more rapid and seamless.  I look forward to future opportunities to work together and share ideas with my fellow corneal surgeons to get the best results for our patients.