DMEK: Probleme vermeiden, erkennen, lösen

Abstract

Descemet membrane endothelial keratoplasty (DMEK) has evolved into a routine surgical procedure for posterior lamellar keratoplasty. After its introduction more than 10 years ago, several modifications in grafting technique and postoperative treatment regimen helped to improve its safety and reproducibility. Although DMEK offers faster and better improvements in visual acuity, as well as less graft rejections when compared to Descemet's stripping (automated) endothelial keratoplasty (DS[A]EK), difficulties when implementing this technique hamper the widespread use in many areas. However, different strategies help to reduce the rate of intra- and postoperative complications, making DMEK the method of choice for most patients with corneal endothelial diseases. Certain techniques help to reduce the endothelial damage during graft preparation; correct matching of donor age and recipient's anterior chamber depth eases intracameral unfolding of the DMEK graft, the use of SF gas for anterior chamber tamponade reduces the need for additional rebubblings, and the correct frequency and duration of postoperative topical steroid treatment helps to reduce the development of cystoid macular edema and graft rejections. Further standardization, but also individualization, of DMEK helps to offer this treatment option to patients with more complex anterior segment situations like anterior synechia, larger iris defects and glaucoma drainage devices.

Effects of uncomplicated Descemet membrane endothelial keratoplasty on the central retinal thickness

“…Conditions associated with the development of ME such as chronic intraocular inflammation, retinal vein occlusion, or systemic risk factors, e.g., diabetes mellitus, have not yet proven to increase the DMEK-ME risk [18][19][20]23]. Most studies analyzing the occurrence of DMEK-ME included eyes with local or systemic risk factors and intra-or postoperative complications [8,[18][19][20][22][23][24].…”

Ultrastructural findings in graft failure after Descemet membrane endothelial keratoplasty (DMEK) and new triple procedure

“…We strongly recommend presurgical marking of the donor Descemet membrane to avoid this complication. [11,12] We think that the need for numerous failing re-bubbling procedures may be a strong sign of upside down transplantation.…”

Rezidivierendes DMEK-Versagen

“…Diese Komplikation lässt sich allerdings durch die prophylaktische hochfrequente Anwendung von topischen Steroiden während der ersten postoperativen Woche signifikant reduzieren [ 2 ]. Ähnlich zeigten Kocaba et al.…”