Descemet's Membrane Endothelial Keratoplasty

Descemet's Membrane Endothelial Keratoplasty (DMEK) is the latest technique for replacing the corneal endothelium. It gives better visual results and a more rapid visual recovery than older techniques. I was taught how to perform this in 2008, when I visited Dr Gerrit Melles, who devised the technique. DMEK is very popular in the USA and Europe. Despite this, there are few, if any, other UK surgeons performing this procedure, largely because it is perceived as being very difficult to learn.

DMEK Preparation

This video shows the preparation of the donor material. The extremely thin “Descemet’s Membrane” and the endothelial cells it carries are carefully peeled from the back of the donor cornea. A blue dye is used to make the transparent membrane slightly more visible. The disc of tissue is transferred to a dish to await transplantation. It rolls into a tight scroll because of the elasticity of the membrane.

DMEK Insertion

The disc of tissue, stained again with blue dye, is sucked up into a glass pipette. It is then injected into the eye (which has been prepared by removing the equivalent diseased tissue).

DMEK Unfolding

In this video, running at 8x real speed, the tissue is unfolded using tiny air bubbles and gentle jets of fluid before being pressed into place with a large air bubble for eight minutes.

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