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DMEK surgery widely adopted in Europe with rewarding results

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VIENNA — DMEK surgery has been widely adopted in Europe with rewarding results, according to one surgeon.

“In Europe, about 40% of the grafts are performed for endothelial dysfunction, mainly for Fuchs dystrophy,” Friedrich Kruse, MD, said at the meeting of the European Society of Ophthalmology.

Friedrich Kruse

In Germany, only his center was performing Descemet’s membrane endothelial keratoplasty (DMEK) in 2009, he said, and now almost all the centers that perform corneal grafting have some experience with this technique.

“A lot of surgeons started with DSEK, but aimed for better visual acuity,” Kruse said.

Despite the technical difficulties, DMEK performs better and needs fewer steroids because graft rejection is far less likely than in Descemet’s stripping endothelial keratoplasty (DSEK) and PK, he added.

“Vision side-by-side comparison showed clear results in favor of DMEK,” he said.

DMEK is the only technique that leads to complete anatomical reconstruction, relying on small incision surgery. The stripping of the graft is low cost.

“You may lose grafts, but you don’t need expensive equipment. We proposed a two-forceps technique,” Kruse said.

DMEK, however, suffers from a considerable lack of standardization, which is manifested in the higher rebubbling rate.

“We need to standardize DMEK. In Europe, we have learned we can get better results from a better donor selection. Older donors have thicker Descemet’s compared with younger donors, and the coiling of the membrane depends on thickness,” Kruse said.

He recommended the use of younger donor grafts, between 50 and 70 years of age, for shallow anterior chambers, while for deep anterior chambers or compromised vitreous situations, older donor grafts, which do not coil as much, should be preferred.

Graft adhesion appears to be dependent on the size of removal.

“If you make a small removal with a large graft and you create an overlap, your graft will not stick as well as a smaller graft with a large removal,” he said.

He personally designed a graft shooter, which administers a tiny air bubble within the tissue, to make insertion and unfolding easier and more manageable. – by Michela Cimberle

Disclosure: Kruse has no relevant financial disclosures.