DMEK Calling

343 The emergence of endothelial keratoplasty (EK) represents the beginning of a new era in the treatment of corneal endothelial disorders which continues to evolve. Fifteen years ago we were performing penetrating keratoplasty for Fuchs’ dystrophy and bullous keratopathy but nowadays we are performing selective replacement of the diseased endothelial layer. In recent years two techniques of EK have risen and prevailed among others; Descemet's stripping automated endothelial keratoplasty (DSAEK) and even more recently Descemet's membrane endothelial keratoplasty (DMEK). In this issue, two articles on EK are published, one on DSAEK and the other on DMEK.[1,2] DSAEK is currently the most common type of EK performed worldwide, but published literature has shown that DMEK has better visual outcomes and with current standardised techniques has also similar endothelial cell loss compared with DSAEK.[3‐6] Moreover, the majority of patients preferred DMEK over DSAEK in a contralateral study.[7] DMEK has the lowest risk of immunological rejection of all types of corneal transplantation because it only replaces Descemet’s membrane and endothelium.[8] DMEK graft preparation is less expensive than DSAEK because it does not require a microkeratome. Trained eye bank technicians can currently prepare grafts with low rate of tissue‐processing failure.[9] In addition, due to shortage of corneal donors worldwide, the possibility of using one donor cornea for preparing Descemet’s membrane for DMEK and full thickness stroma for deep anterior lamellar keratoplasty (DALK) in eye banks is promising.[10] There are also temptations to split a single Descemet membrane for use in 2 or even 4 patients.[11,12] Despite all its advantages, DMEK surgical technique is more challenging than DSAEK and the steep learning curve still remains a major drawback when established DSAEK surgeons consider adopting the technique.[6,13,14] In that scenario transition towards DMEK seems to happen gradually and slower than initially predicted. Graft detachment requiring air re‐bubbling is common in DMEK; especially during DMEK Calling