Descemet Membrane Endothelial Keratoplasty (DMEK) and Descemet Stripping Endothelial Keratoplasty (DSEK)

There are a variety of corneal conditions that cause swelling of the cornea and can lead to cloudy vision, eye discomfort, and, over the course of time — gradual and permanent vision loss. Some of these conditions that cause corneal swelling may run in families such as Fuchs’ Corneal Dystrophy or may occur after surgery or injury to the eye.

If you have been diagnosed with corneal swelling, or if your doctor has recommended a corneal transplant, you may be a candidate for Descemet membrane endothelial keratoplasty (DMEK) or Descemet stripping endothelial keratoplasty. The procedure is an alternative to the conventional cornea transplant in which the whole thickness of the cornea is replaced. DMEK and DSEK allow for only a small layer of the inner cornea to be replaced. In DMEK and DSEK, the innermost layers of the cornea are replaced with a cornea that has been donated by a deceased person. DSEK is a slightly thicker cornea graft compared to DMEK. 

Because these transplants cannot be easily sutured into place as they are on the inside of the eye, a small air bubble or gas bubble is placed underneath the graft on the inside of the eye in order to keep the graft in place. Patients are often asked after surgery to maintain positioning laying on their back (“eyes up to the ceiling”) so that the bubble may allow best adherence of the new cornea graft to your cornea. The time required for positioning may vary, but usually ranges over a few days post operatively. You will be allowed 10 to 15 minutes of each hour to be upright in order to eat, drink, or use the restroom during this time of positioning. Your surgeon will check you frequently in the postoperative period to ensure the new graft is attaching well to your cornea. Occasionally, due to the thin profile of these grafts, they may “detach” slightly from your cornea and may require additional gas or air bubble to be placed within the first few weeks of surgery to facilitate better adherence. 

DMEK and DSEK have been shown to improve visual acuity, donor cornea graft survival, and endothelial cell loss when compared to a full thickness corneal transplant.

Are You a Candidate for DMEK or DSEK?

The U-M Kellogg Eye Center team will evaluate patients with corneal disorders to determine whether DMEK or DSEK is appropriate for their condition. The procedure is approved and intended for patients with Fuchs’ corneal dystrophy, corneal edema after cataract surgery, and failed corneal transplants.

To learn more about DMEK or DSEK, please schedule an appointment with the Cornea, Cataract and Refractive Surgery Clinic at 734-764-5106.

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