Descemet-Membran-Endothelkeratoplastik (DMEK)

Abstract

Descemet membrane endothelial keratoplasty (DMEK) is the gold standard for the treatment of corneal endothelial disease, first and foremost Fuchs' endothelial dystrophy. Superior visual rehabilitation as well as lower and decreasing complication rates can be obtained with DMEK than with Descemet stripping automated endothelial keratoplasty (DSAEK) - still the most commonly performed type of posterior lamellar keratoplasty. Recent advancements in the DMEK method include the establishment of a standardised and reproducible surgical "no touch" technique and the emerging role of eye banks, which are able to prepare convenient pre-cut DMEK grafts. These developments pave the way for increasing numbers of corneal surgeons to add DMEK to their armamentarium, despite the more challenging nature of this procedure. However, a review of the current literature shows that this fascinating technique still offers certain challenges, which need to be further addressed. For example, graft detachment remains the most commonly encountered complication after DMEK. A plethora of prospective-randomised studies is required to further endorse the evident superiority of DMEK over alternative types of lamellar keratoplasty and to help propagate the practice of this fascinating technique.