descemet's membrane endothelial keratoplasty (dmek)
TRANSCRIPT
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Descemet’s Membrane Endothelial Keratoplasty(DMEK)
Charles S. Ahn, MDMedical Director
Dupage Medical Group Eye Specialists
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Corneal Anatomy
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ALK ‐ Superficial
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DALK
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PK
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PLK = DLEK
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DSLEK
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DSAEK
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PK vs. DSAEK
DSAEK
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Visual Recovery Time
12 Months
6 Months
5 Months
1Month
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Treatment of Endothelial Disease
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•Penetrating Keratoplasty
•Endothelial Keratoplasty•Posterior Lamellar Keratoplasty (PLK)•Descemet’s Stripping Automated Endothelial
Keratoplasty (DSEK/DSAEK)•Descemet’s Membrane Endothelial Keratoplasty
(DMEK)
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“SELECTIVE REPLACEMENT OF DISEASED OR DAMAGED POSTERIOR
LAYERS OF THE CORNEA”12
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DSAEK Procedure
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3 Major Challenges with DSAEK
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•Visual Acuity•Suboptimal•Visual rehabilitation is relatively slow
•Accessibility to tissue•Investment in equipment•Purchase of predissected tissue
•Drop in donor endothelial cell density in the early postoperative phase
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Who Moved My Cheese?
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History of DMEK
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•2002, Melles et al published a possible technique for transplanting DM and endothelium.
•2006, Melles published a case of a patient achieving 20/20 vision at week 1 with DMEK.
•2007, Art Giebel presented the SCUBA technique at AAO for harvesting the graft
•2009, Francis Price presented results of DMEK indicating they may be superior to DSAEK
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Potential Advantages of DMEK
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•Great Visual Results
•Quick Recovery
•Use of inexpensive techniques
•Increased availability
•Decrease crowding of the anterior chamber (i.e. tube shunt)
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Challenges with DMEK
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•New skills and techniques
•Successful and reliable harvesting of the donor graft
•Intraocular placement and positioning of the graft
•Postoperative management – successful attachment of the graft
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Harvesting the Graft
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•SCUBA technique•Art Giebel•Submerged Cornea Using Backgrounds Away•Addresses :
•Handling•Visualization (Red Reflex)
•Viewing Chamber for Donor Graft•Barron Donor Punch
•Trypan Blue
•Use a trephine
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Implanting the Donor Membrane
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•Insertion of the membrane•Staar injector
•Orientation•“Dead Sea Scrolls”
•Unwrapping•BSS with a cannula•Air
•Positioning
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1 Day DMEK Postop
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DMEK Postop
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Edge of DMEK Graft
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Edge Interface
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DSAEK Graft
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Partial Detachment with DMEK
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DSAEK Visante OCT
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Conclusions
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•DMEK appears to be an effective method in managing corneal endothelial disorders providing quick and excellent visual rehabilitation.
•Need more long-term follow-up and data.
•Need improved techniques in handling, positioning, and attaching graft.
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g{tÇ~ lÉâ
Charles S. Ahn, MDMedical Director
Dupage Medical Group Eye Specialists
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Prechopping Technique
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Prechopping Technique
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Prechopping Technique
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Prechopping Technique
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Prechopping Technique
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Prechopping Technique
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Prechopping Technique
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Prechopping Technique
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Hybrid Prechopper Closed
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Prechopping Video
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Prechopping Video 2