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Learning Descemet's membrane endothelial keratoplasty (DMEK): is prior experience with descemet stripping endothelial keratoplasty (DSEK) essential?

Poster Details

First Author: M.Ziaei UK

Co Author(s):    M. Bhogal   B. Allan                 

Abstract Details


This study aims to report the initial DMEK outcomes of two trainee surgeons operating under supervision with no significant prior experience with DSEK (less than 10 cases).


Cornea and External Diseases Service, Moorfields Eye Hospital, London, UK.


Prospective single center study. 40 eyes of 35 patients with endothelial failure undergoing DMEK or combined phaco-DMEK. Unicameral eyes, eyes with previous glaucoma shunt surgery, and vitrectomised eyes were excluded. 8-8.5mm diameter grafts were prepared using the peripheral scoring technique and injected into the eye using a glass cannula. A cohesive ophthalmic viscoelastic device was utilised in 95% of cases for Descemetorhexis. All patients had a complete anterior chamber air fill for 1 hour postoperatively before air fill adjustment to prevent pupil block. The rates of intraoperative complications, peripheral detachment, repeat air fill, and primary graft failure were recorded.


Graft preparation was successful in all cases with no loss of tissue. Surgery was uneventful in 90% of cases. One case required intraoperative re-staining of the DMEK graft whilst another case was complicated by significant iris bleeding from the peripheral iridotomy. Partial detachments were seen in (10/40) 25% of cases. 12.5% of eyes required a single rebubbling procedure with air which resulted in complete graft attachment in all cases. Primary graft failure occurred in 5% of cases.


Our clinical outcomes are in keeping with that reported in the literature from a multicenter study evaluating the initial DMEK case series of 18 experienced corneal surgeons. Lack of experience with older endothelial keratoplasty techniques such as DSEK is therefore not a significant barrier towards learning DMEK using a standardized technique and case selection criteria.

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