DMEK Cornea Transplant: When and How to Operate

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The new DMEK Cornea Transplant represents the best solution for those suffering from cornea guttata , corneal edema and Fuchs’ Dystrophy. This cornea transplant allows you to see well again just one month after the operation, it is performed without stitches, and has the lowest risk of rejection among all types of cornea transplant. We interview Dr. Badalà, who has just organized in Paris, during the congress of the European Cornea Society (EUcornea), an advanced course to teach numerous eye surgeons, coming from all over the world, this new cornea transplant technique called DMEK. “The European Society of Corneal Surgeons held a course on the new DMEK corneal transplant which gives our patients results never seen before with other corneal transplant techniques – states Badalà -. I had the pleasure of organizing this course with the best DMEK cornea transplant experts from all over Europe and the United States”.

The New DMEK Cornea Transplant

I was the first to introduce this technique in Milan in 2013 and since then we have greatly refined the operating strategy which is now safe and effective. The new cornea transplant is called DMEK, i.e. Descemet Membrane Endothelial Keratoplasty and allows you to solve problems of corneal edema by simply replacing the endothelial cells of the cornea damaged by diseases such as Fuchs’ dystrophy, guttate cornea or by complicated cataract surgery.

The Dr. Badalà at the EUcornea 2019 Congress in Paris

The operation takes about an hour and can be performed under local anesthesia. The new cells are prepared by the surgeon from a human cornea and then inserted into the eye; at this point a gas bubble is inserted inside the eye which serves to fix the new cells in their place. It is essential for the success of this operation that the patient maintains the supine position for a few days after the cornea transplant, in order to allow the new cells to fix themselves in the right place”. “During the course we taught the surgeons how to do to prepare the cells to be transplanted and how to transfer them and fix them inside the eye safely – continues Badalà – the various teachers of the course, who have developed the most innovative techniques for this corneal transplant, explained all the methods to reduce the complications to a minimum”. Professors from the main European and American universities participated: Sadeer Hannush, Thomas Jefferson University – Philadelphia, USA; Martin Dirisamer, University of Munich – Munich, Germany; Friedrich Kruse, University of Erlangen – Erlangen, Germany; Beeran Meghpara, Thomas Jefferson University – Philadelphia, USA; Alain Saad, America University of Beirut – Beirut, Lebanon; Christopher Sales, Cornell University, New York, USA; Michael Straiko, Devers Eye Institute – Portland Oregon, USA; Theofilos Tourtas, University of Erlangen – Erlangen, Germany; Peter Veldman, University of Chicago – Chicago Illinois, USA; This has allowed us to offer different operative strategies to surgeons who wish to learn DMEK cornea transplantation.”

The Old Conventional Cornea Transplant and DSAEK

Traditional corneal transplant DSAEK Until a few years ago, the solutions for those suffering from corneal edema were an entire cornea transplant, called Perforating Keratoplasty or PKP, in which the entire cornea was replaced with visual recovery that required about a year, or DSAEK in which a piece of donor cornea was transplanted together with the damaged endothelial cells. DSAEK represented a step forward compared to the transplant of the entire cornea, but for some years it has been replaced by DMEK as the best intervention for all problems of corneal edema, because with DMEK less donor tissue is transferred compared to DSAEK and therefore visual recovery is faster and the risk of rejection is lower than with DSAEK. In summary, compared to the old operating techniques (DSAEK and conventional corneal transplant) used to treat corneal edema, cornea guttata and Fuchs’ dystrophy, the new DMEK transplant presents two great advantages: Much faster visual recovery Extreme risk of rejection reduced

When and how to operate with the DMEK Cornea Transplant

We want to give a message of hope to our patients. The DMEK cornea transplant today is safe and effective, it allows you to solve the problem of corneal edema and guttate cornea in just a month. The new operating technique can be learned during courses like this which give the surgeon the opportunity to learn in a guided way with a simulation very close to the operating reality. It is therefore possible to operate on a patient suffering from corneal edema as soon as the first symptoms appear without waiting for the vision to be seriously compromised because the risks with the DMEK cornea transplant are extremely reduced. Furthermore, in very selected cases, today one can also think of the brand new DWEK (Descemetorexis Without Endothelial Transplant) technique in which, thanks to medical therapy, the problem can be solved without even resorting to a transplant of donor cells.

More insights on cornea transplant

You can learn more about this cornea transplant technique during the courses that we regularly hold at the congresses of scientific societies ( EUcornea , ESCRS – European Society of Cataract & Refractive Surgeons , AAO – American Academy of Ophthalmology, ASCRS – American Society of Cataract and Refractive Surgery), European and American themes or listening to the experiences of patients operated with this type of operation in the testimonials section.