Our Summary

This research paper discusses a relatively new technique for corneal transplantation surgery called Descemet membrane endothelial keratoplasty (DMEK). This method is used to treat patients with a specific type of eye condition known as endothelial insufficiency.

The paper highlights that DMEK is increasingly being preferred by surgeons due to its excellent results in terms of improved vision and faster recovery time for patients after the surgery. Additionally, it has been found to have a lower risk of the body rejecting the transplant (1-2%), is less expensive than other procedures and does not require the use of high-cost equipment.

Another significant benefit of DMEK is the efficient use of donor corneal tissue, which can be used for several patients. For example, after using certain parts of the cornea for a patient suffering from endothelial dysfunction, the remaining parts can be used to treat another patient with different corneal problems.

The main challenges associated with this procedure are the technical difficulties encountered during the preparation of the graft (transplanted tissue) and the surgery itself. However, surgeons have reported good results once they gain experience with the technique.

The paper reviews the latest clinical trials on DMEK, offering a detailed analysis of its advantages and disadvantages.

FAQs

  1. What is Descemet membrane endothelial keratoplasty (DMEK) and what conditions does it treat?
  2. What are the advantages of DMEK over other corneal transplantation methods?
  3. What are the challenges associated with the DMEK procedure?

Doctor’s Tip

Overall, a doctor might advise a patient considering a corneal transplant to discuss with their surgeon the option of DMEK, as it has shown promising outcomes in terms of visual acuity and recovery time. It is important for patients to understand the potential benefits and risks associated with this procedure in order to make an informed decision about their treatment.

Suitable For

Overall, patients who are typically recommended for a corneal transplant, specifically a DMEK procedure, are those with endothelial insufficiency, which can result from conditions such as Fuchs’ endothelial dystrophy, pseudophakic bullous keratopathy, or iridocorneal endothelial syndrome. These patients may experience symptoms such as blurred vision, glare, and decreased visual acuity due to the dysfunction of the endothelial cells in the cornea.

Additionally, patients who have failed previous corneal transplant surgeries or who have corneal scarring, thinning, or irregularities may also be candidates for a DMEK procedure. It is important for patients to undergo a thorough evaluation by an ophthalmologist to determine if they are suitable candidates for corneal transplantation and to discuss the potential risks and benefits of the procedure.

In conclusion, patients with endothelial insufficiency or other corneal conditions that cannot be effectively treated with other methods may be recommended for a corneal transplant, particularly a DMEK procedure. This innovative technique offers significant advantages in terms of visual outcomes, recovery time, and cost-effectiveness, making it a preferred option for many patients in need of corneal transplantation surgery.

Timeline

Before the corneal transplant:

  • Patient undergoes a comprehensive eye examination to determine the need for a corneal transplant
  • Patient is informed about the procedure, risks, benefits, and recovery process
  • Patient is placed on a waiting list for a donor cornea
  • Donor cornea is matched to the patient’s eye
  • Surgery date is scheduled

After the corneal transplant:

  • Patient undergoes the DMEK surgery, which involves replacing the damaged endothelial layer of the cornea with a healthy donor tissue
  • Patient is monitored closely for any signs of complications or rejection of the transplant
  • Patient may experience temporary blurred vision, discomfort, and sensitivity to light
  • Patient is prescribed eye drops to prevent infection and promote healing
  • Follow-up appointments are scheduled to monitor the progress of the transplant and adjust medications if needed
  • Patient gradually experiences improved vision and overall eye health as the transplanted cornea heals and integrates with the eye tissue

Overall, the timeline of a patient’s experience before and after a corneal transplant involves thorough evaluation, preparation, surgery, recovery, and follow-up care to ensure successful outcomes.

What to Ask Your Doctor

Some questions a patient should ask their doctor about corneal transplant surgery, specifically regarding DMEK, include:

  1. What is DMEK and why are you recommending it as a treatment option for my condition?
  2. What are the potential risks and complications associated with DMEK surgery?
  3. How long is the recovery period after DMEK surgery and what can I expect in terms of vision improvement?
  4. Are there any specific post-operative care instructions I need to follow to ensure the success of the transplant?
  5. How experienced are you in performing DMEK surgeries and what is your success rate with this procedure?
  6. Will I need to take any medications after the surgery to prevent rejection of the transplant?
  7. Are there any restrictions or lifestyle changes I need to make after undergoing DMEK surgery?
  8. What are the chances of needing a repeat transplant in the future with DMEK compared to other types of corneal transplant procedures?
  9. How long will the benefits of DMEK surgery last, and what is the expected long-term outcome for my vision?
  10. Are there any alternative treatment options to consider before proceeding with DMEK surgery?

Reference

Authors: Malyugin BE, Shilova NF, Anisimova NS, Antonova OP. Journal: Vestn Oftalmol. 2019;135(1):98-103. doi: 10.17116/oftalma201913501198. PMID: 30830081