LaserVision

DMEK treatment at a glance

Treatment Time

30 minutes

Anaesthetic

Local anaesthetic

Downtime

7-14 days

Longevity

Permanent

Key Benefit

Improved Vision

What is a DMEK procedure ?

Descemet’s membrane endothelial keratoplasty (DMEK) is a corneal transplantation procedure, replacing only the innermost layers of the cornea, namely the Descemet membrane and endothelium, with human corneal donor tissue. This makes DMEK different from another partial thickness procedure,  DSAEK ( Descemet’s stripping automated endothelial keratoplasty) which also replaces the posterior stroma. A DMEK procedure helps to improve corneal clarity against cloudiness caused by injury or other eye conditions like fuchs endothelial dystrophy. 

DMEK

DMEK procedure

The faulty inner layer of corneal cells is removed and replaced with the layer of cells taken from a donated human cornea. In a DMEK procedure the implanted donor material contains only Descemet’s membrane and corneal endothelial cells (15-20 microns thick) and is therefore a like-for-like replacement of tissue. Medical conditions including: Fuchs’ dystrophy, bullous keratopathy, iridocorneal endothelial (ICE) syndrome, or other endothelial disorders may cause blurry or cloudy vision and glare. An EK corneal transplantation selectively replaces only the diseased layer of the cornea, leaving healthy areas intact.

DMEK procedure

The faulty inner layer of corneal cells is removed and replaced with the layer of cells taken from a donated human cornea. In a DMEK procedure the implanted donor material contains only Descemet’s membrane and corneal endothelial cells (15-20 microns thick) and is therefore a like-for-like replacement of tissue. Medical conditions including: Fuchs’ dystrophy, bullous keratopathy, iridocorneal endothelial (ICE) syndrome, or other endothelial disorders may cause blurry or cloudy vision and glare. An EK corneal transplantation selectively replaces only the diseased layer of the cornea, leaving healthy areas intact.

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Treatment Benefits Benefits

What are the benefits of DMEK (Descemet’s Membrane Endothelial Keratoplasty)?

  • Improve vision
  • Treat corneal failure / decompensation

How is it performed?

  • 1.Performed under local or general anaesthetic in sterile operating theatre.
  • 2.Patient is laid flat on the treatment bed.
  • 3.Povidone iodine clean, sterile drape applied, and eyelid support inserted.
  • 4.Faulty / failing corneal endothelium is removed and the donor cornea endothelial transplant inserted.
  • 5.Graft is secured in place with air or an SF6 bubble which tamponades the graft against the inside of the cornea.
  • 6.Topical anti-inflammatory eye drops and antibiotic eye drops are applied and patients are advised to lie flat on their back as much as possible (45 minutes in every hour) for the first 2-3 days post-surgery.
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Descemet's Membrane Endothelial Keratoplasty: FAQs

A Descemet’s membrane endothelial keratoplasty (DMEK) is very similar to DSAEK, except that the implanted donor tissue does not include any stromal tissue. DMEK surgery is a replacement of solely endothelium and is thus a more anatomically like-for-like repair. minimising risk of corneal transplant rejection. 

Visual recovery after DMEK surgery takes 1-4 weeks. Typically, vision is poor in the first few days due to the air bubble. Vision begins to improve once the bubble is above the level of the pupil. Good vision and visual acuity can be expected a month after surgery and the patient may notice small incremental improvements up to 12 months following surgery. New glasses can typically be measured 6 weeks after surgery.

The front anterior chamber of the eye will be filled with gas / air which causes a temporary reduction in vision. It is not possible to see through an air bubble in the eye. Vision will typically be worse than before the surgery until the gas bubble is reabsorbed. You will be able to see light and blurred shapes. You will not be able to read with the operated eye. As the air bubble absorbs and disappears, it will move upwards (air floats on water), and one may be able to see the meniscus of the bubble as a dark curved line in your vision. The bubble can be seen externally if you look at the eye in the mirror. Once the air is above the level of the pupil, vision will begin to return. The air bubble will typically disappear completely 5-7 days after surgery. If you have had a vitrectomy in the past there can also be air that travels to the back of the eye and you may then see two bubbles. This will also disappear. Some irritation, grittiness or aching of the eye is normal after DMEK. Severe pain is unusual. The eye can also feel itchy. It is important not to rub or touch the eye. Follow the instructions you were given regarding medication.

The following are potential effects of the DMEK corneal transplant: elevated intraocular pressure, graft dehiscence or graft dislocation, infection and allergies.

 Endothelial keratoplasty takes around 30 minutes and is usually performed under local anaesthetic. It can be combined with cataract surgery if required

Treatment Options

Choosing the right vision correction clinic for your DMEK surgery is crucial. This is a life changing corneal procedure after all, and you need to have complete trust in your eye surgeon and care team of professionals.

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