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

  • Christopher S. Sáles
  • Zachary M. Mayko
  • Mark A. Terry
  • Michael D. StraikoEmail author


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.


Anterior Chamber Donor Tissue Endothelial Cell Density Penetrate Keratoplasty Descemet Strip Automate Endothelial Keratoplasty 
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  1. 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.CrossRefPubMedGoogle Scholar
  2. 2.
    Dapena I, Moutsouris K, Droutsas K, et al. Standardized “no-touch” technique for descemet membrane endothelial keratoplasty. Arch Ophthalmol. 2011;129:88–94.CrossRefPubMedGoogle Scholar
  3. 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.CrossRefPubMedGoogle Scholar
  4. 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.CrossRefPubMedGoogle Scholar
  5. 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.CrossRefPubMedGoogle Scholar
  6. 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.CrossRefPubMedGoogle Scholar
  7. 7.
    Price MO, Price Jr FW. Descemet stripping with endothelial keratoplasty for treatment of iridocorneal endothelial syndrome. Cornea. 2007;26:493–7.CrossRefPubMedGoogle Scholar
  8. 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.CrossRefPubMedGoogle Scholar
  9. 9.
    Heinzelmann S, Huther S, Bohringer D, et al. Influence of donor characteristics on descemet membrane endothelial keratoplasty. Cornea. 2014;33:644–8.CrossRefPubMedGoogle Scholar
  10. 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.CrossRefPubMedGoogle Scholar
  11. 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. 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.CrossRefPubMedGoogle Scholar
  13. 13.
    Gorovoy MS. DMEK complications. Cornea. 2014;33:101–4.CrossRefPubMedGoogle Scholar
  14. 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. 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.CrossRefPubMedGoogle Scholar
  16. 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.CrossRefPubMedGoogle Scholar
  17. 17.
    Gorovoy IR, Cui QN, Gorovoy MS. Donor tissue characteristics in preparation of DMEK grafts. Cornea. 2014;33:683–5.CrossRefPubMedGoogle Scholar
  18. 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.CrossRefPubMedGoogle Scholar
  19. 19.
    Tenkman LR, Price FW, Price MO. Descemet membrane endothelial keratoplasty donor preparation: navigating challenges and improving efficiency. Cornea. 2014;33:319–25.CrossRefPubMedGoogle Scholar
  20. 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.CrossRefGoogle Scholar
  21. 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.CrossRefPubMedGoogle Scholar
  22. 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.CrossRefPubMedGoogle Scholar
  23. 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.PubMedGoogle Scholar
  24. 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.CrossRefPubMedGoogle Scholar
  25. 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.CrossRefPubMedGoogle Scholar
  26. 26.
    Kruse FE, Schrehardt US, Tourtas T. Optimizing outcomes with Descemet’s membrane endothelial keratoplasty. Curr Opin Ophthalmol. 2014;25:325–34.CrossRefPubMedGoogle Scholar
  27. 27.
    Liarakos VS, Dapena I, Ham L, et al. Intraocular graft unfolding techniques in descemet membrane endothelial keratoplasty. JAMA Ophthalmol. 2013;131:29–35.CrossRefPubMedGoogle Scholar
  28. 28.
    Burkhart ZN, Feng MT, Price MO, Price FW. Handheld slit beam techniques to facilitate DMEK and DALK. Cornea. 2013;32:722–4.CrossRefPubMedGoogle Scholar
  29. 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.CrossRefPubMedGoogle Scholar
  30. 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.CrossRefPubMedGoogle Scholar
  31. 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.CrossRefPubMedGoogle Scholar
  32. 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.CrossRefPubMedGoogle Scholar

Copyright information

© Springer India 2016

Authors and Affiliations

  • Christopher S. Sáles
    • 1
  • Zachary M. Mayko
    • 2
  • Mark A. Terry
    • 3
  • Michael D. Straiko
    • 3
    Email author
  1. 1.Weill Cornell MedicineNew YorkUSA
  2. 2.Lions VisionGiftPortlandUSA
  3. 3.Devers Eye InstitutePortlandUSA

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