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.
• 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.
• 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.
• To the best of our knowledge: None.
• 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.
I. Vital dyes for intraocular use
II. Advanced surgical techniques for corneal transplantation
III. Alternative surgical settings and logistics