dMeK: the new Standard for Lamellar Keratoplasty

D escemet membrane endothelial keratoplasty (DMEK), the newest and most advanced form of endothelial transplantation, represents the culmination of the evolution of keratoplasty techniques. It has nudged aside its predecessor, Descemet stripping automated endothelial keratoplasty (DSAEK), just as DSAEK displaced its own forerunner, deep lamellar endothelial keratoplasty (DLEK). What differentiates DMEK from previous versions of the operation is its unparalleled precision. With a graft consisting of a single layer of endothelial cells and their basement membrane, DMEK achieves an exact, oneto-one replacement of a patient’s diseased Descemet membrane with donor tissue. The result is near-perfect restoration of the recipient cornea’s natural anatomy (Figure 1).1 Many ophthalmologists are reluctant to learn DMEK, largely because the previous gold standard, DSAEK, proved so successful. But now, after more than 10 years of study and thousands of operations, the data comparing the two surgeries seem hard to ignore: For most patients, DMEK offers better postoperative outcomes and fewer problems.2-11 We invite all corneal surgeons—whatever their previous level of experience—to bite the bullet and make the switch, for the reasons outlined below.