DMEK best option for long-term graft survival

Descemet’s membrane endothelial keratoplasty (DMEK) appears to offer the best option today for long-term graft survival for the management of endothelial dysfunction, but remains a challenging procedure, Donald Tan FRCS told delegates in his EuCornea Medal Lecture delivered at the 11th EuCornea Congress. In a wide-ranging and entertaining lecture, Dr Tan spoke about the paradigm shift in corneal transplantation techniques in recent years away from penetrating keratoplasty towards lamellar and endothelial keratoplasty approaches and explained how national and international registries could help to inform better management of these challenging cases. “The establishment of corneal transplant registries and tracking of results with long-term data, coupled with surgical innovation and appropriate training of corneal surgeons, can definitely result in improved outcomes,” he said. Dr Tan highlighted the role that improved instrumentation and innovative surgical techniques can play in delivering improved outcomes and enhanced survival rates. “For instance, my ‘pull through endo-in’ approach provides good control of the DMEK donor, reduces the risk of inadvertent donor eversion and also provides for a more controlled chamber depth during donor manipulation compared to conventional DMEK,” he said. Dr Tan said that his latest approach for complex cases with anterior chamber abnormalities is to first reconstitute the anatomy of the chamber by removing abnormal iris and re-establishing the posterior surface of the anterior chamber with the artificial iris. “This paves the way for a more uneventful DMEK procedure. With better surgical control, we can now perform more complex cases where anterior segment and chamber abnormalities may make conventional DMEK a real challenge,” he said.

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