II.2.e Posterior lamellar keratoplasty / Descemet membrane endothelial keratoplasty (PLK/DMEK)

Topic II.2.e – Posterior lamellar keratoplasty / Descemet membrane endothelial keratoplasty (PLK/DMEK)

The far majority of corneal endothelial disorders is limited to the endothelial cell layer and Descemet membrane. Endothelial malfunctioning may result in corneal edema and Hassle Henle warts may reduce the optical performance of the cornea through distortion and light scattering. From an anatomical point of view, transplantation of only the endothelium / Descemet membrane complex would be most efficient. The intraocular changes would be minimal, the antigen load minimized, and risks of interface haze eliminated in the absence of stromal interfaces.

However, Descemet membrane may be too fragile to allow dissection of the membrane from a donor cornea during surgery. For the technique to become successful, the support of an eyebank seemed mandatory for the preparation of the donor tissue prior to the surgery. Although initially presented in 1998, it lasted until 2004 before the logistics could be set up to perform this technique (Descemet membrane endothelial keratoplasty (DMEK)) clinically, following the start of Amnitrans Eyebank Rotterdam.

Prior art

• Lange TM, Wood TM, McLaughlin BJ. Corneal endothelial cell transplantation using Descemet’s membrane as a carrier. J Cataract Refract Surg 1993;19:232-235.

NIIOS Contributions

• Melles GRJ, Rietveld FJR, Pels E, Beekhuis WH, Binder PS: Transplantation of Descemet’s membrane carrying viable endothelium through a small scleral incision. American Society Corneal Refractive Surgery 1998:49.
• Melles GRJ, Rietveld FJR, Pels E, Beekhuis WH, Binder PS: Transplantation of Descemet’s membrane carrying viable endothelium through a small scleral incision. Invest Ophthalmol Vis Sci 1998;39(suppl):S76, abstract no 343.
• Melles GRJ, Lander F, Rietveld FJR: Transplantation of Descemet’s membrane carrying viable endothelium through a small scleral incision. Cornea 2002;21:415-418.
• Melles GRJ, Lander F, Rietveld FJR: Comment on Transplantation of Descemet’s membrane carrying viable endothelium through a small scleral incision (Letter). Cornea 2002;21:840.
• Melles GRJ, Ong S, Ververs B, Van der Wees J. Descemet membrane endothelial keratoplasty (DMEK). Cornea 2006, In press.
• Melles GRJ. Posterior lamellar keratoplasty: DLEK to DSEK to DMEK (editorial). Cornea 2006, In press.

Parallel developments

• To the best of our knowledge: None.

Spin off

• Sharma A, Woodman A. Comment on transplantation of Descemet's membrane carrying viable endothelium through a small scleral incision. Cornea 2002;21:840; author reply 840.
• Shimmura S, Miyashita H, Konomi K, Shinozaki N, Taguchi T, Kobayashi H, Shimazaki J, Tanaka J, Tsubota K. Transplantation of corneal endothelium with Descemet's membrane using a hydroxyethyl methacrylate polymer as a carrier. Br J Ophthalmol 2005;89:134-137.
• Ignacio TS, Nguyen TT, Sarayba MA, Sweet PM, Piovanetti O, Chuck RS, Behrens A. A technique to harvest Descemet's membrane with viable endothelial cells for selective transplantation. Am J Ophthalmol 2005;139:325-330.

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