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Thinner grafting procedure more delicate, but may offer improved visual outcomes

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SAN FRANCISCO — A new endothelial keratoplasty procedure in which the surgeon transplants only Descemet's membrane and attached endothelium may offer improved visual acuity over other endothelial keratoplasty procedures, according to a speaker here.

Because Descemet's membrane endothelial keratoplasty (DMEK) is performed through a 2.8-mm incision, the procedure is "refractive neutral" and these patients may be candidates for premium IOLs, Francis W. Price Jr., MD, said during the joint meeting of the American Academy of Ophthalmology and Pan-American Association of Ophthalmology.

However, because only a very thin portion of the donor cornea is used, the cornea can rip or tear during preparation. An alternative to DMEK, in which a microkeratome is used to prepare the donor cornea (DMAEK), may be a viable option, and it requires only a 3.5-mm incision, according to Dr. Price. Both surgeries offer equivalent vision at 3 months as patients at 6 months after Descemet's stripping endothelial keratoplasty.

"DMEK or DMAEK will become the preferred method if donor preparation can be improved," Dr. Price said.