DSEK still useful in challenging corneal transplant cases
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SAN FRANCISCO — Although Descemet’s membrane endothelial keratoplasty is gaining popularity, Descemet’s stripping endothelial keratoplasty still has a place in challenging cases, according to an expert.
At Cornea Subspecialty Day at the American Academy of Ophthalmology meeting, Jodhbir S. Mehta, MBBS, PhD, FRCOphth, FRCS(Ed), FAMS, said DSEK remains the most common endothelial keratoplasty procedure performed worldwide. Although early use of the technique was limited to cases with moderate corneal clarity, changes in graft insertion techniques have expanded the scope of the procedure to more challenging cases.
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Mehta said DMEK has been gaining traction and has even become the preferred method in some centers. In 2022, Mehta said 97% of his endothelial keratoplasty grafts were DMEK because the procedure has a few advantages.
First, it has faster visual rehabilitation over the first 6 to 9 months. Also, there is less aberration from the posterior corneal surface, leading to better visual acuity, and less rejection.
In DMEK procedures, Mehta said good visibility is required, which can limit its use in some cases. Although changes in techniques have started to expand the procedure into more complex cases, Mehta said DSEK is still useful in challenging eyes.
“Where I do DSEK now is really in patients that have very severe scarring with very poor visibility, patients with severe stromal edema with more granular changes that may require [deep anterior lamellar keratoplasty] afterwards or in children in whom posture is going to be an issue,” he said.
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Mehta JD. DSEK: When DMEK just won’t do. Presented at: American Academy of Ophthalmology meeting; Nov. 3-6, 2023; San Francisco.
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