Innovations in endothelial keratoplasty

Two of the latest iterations of endothelial keratoplasty have the potential to simplify surgery and to make more efficient use of donor tissue, Gerrit Melles MD, PHD , Director, Netherlands Institute for Innovative Ocular Surgery (NIIOS), told a session of  the World Cornea Congress VII in San Diego.Dr Melles, who played a key role in the development of Descemet’s membrane endothelial keratoplasty (DMEK), discussed hemi-DMEK and Descemet’s membrane mediated endothelial transfer (DMET).

Hemi-DMEK involves dissecting the entire Descemet’s membrane, then cutting it in half so that there are two half moon shaped grafts. The surgical technique is the same as DMEK, but requires a different technique at the eye bank. Visual acuity results are also similar to those seen with standard DMEK procedure, with the principle advantage being that one donor cornea can be used for procedures.

DMET involves injecting free-floating donor Descemet’s cells in the recipient anterior chamber after performing a descemetorhexis on the host. The procedure is less complicated than DMEK, and has proven effective in the treatment of Fuch’s dystrophy. However, it takes longer for the cornea to clear with DMET than with DMEK, Dr Melles reported.