Demystifying DMEK Disclosure Anthony J. Aldave,...

Demystifying DMEK

Making The Transition

Course Number 251: New and Emerging Technologies in

Cataract and Refractive Surgery

Annual Meeting of the American Academy of

Ophthalmology

November 15, 2015

Anthony J. Aldave, M.D.

Professor of Ophthalmology

Chief, Cornea and Uveitis Division

The Jules Stein Eye Institute

The University of California, Los Angeles

Disclosure Anthony J. Aldave, M.D.

•Consultant (ad hoc) •Allergan

•Avellino Laboratories

•Research Funding •National Eye Institute

•Speaker’s Bureau •Alcon

•Allergan

•Avellino Laboratories

•Travel Support •Thea Laboratories

Demystifying DMEK

Why make the Transition? •Does not require lamellar corneal dissection

•Microkeratome not required for automated lamellar dissection

•Better visual acuity

•Lower incidence of endothelial rejection

Rodríguez-Calvo-de-Mora M, Quilendrino R, Ham L, Liarakos VS, van Dijk K, Baydoun L, Dapena I, Oellerich S, Melles GR. Clinical

outcome of 500 consecutive cases undergoing Descemet's membrane endothelial keratoplasty. Ophthalmology. 2015;122:464-70.

Goldich Y, Showail M, Avni-Zauberman N, Perez M, Ulate R, Elbaz U, Rootman DS. Contralateral eye

comparison of Descemet membrane endothelial keratoplasty and Descemet stripping automated endothelial

keratoplasty. Am J Ophthalmol. 2015;159:155-9.

Rodríguez-Calvo-de-Mora M, Quilendrino R, Ham L, Liarakos VS, van Dijk K, Baydoun L, Dapena I, Oellerich S, Melles GR. Clinical

outcome of 500 consecutive cases undergoing Descemet's membrane endothelial keratoplasty. Ophthalmology. 2015;122:464-70.

DSEK

Post-Operative Complications

Aldave AJ, Chen JL, Zaman A, Deng SX, Yu F. Outcomes following DSEK in 101 eyes with previous trabeculectomy and tube shunt

implantation. Cornea 2014; 33:223-9.

Demystifying DMEK Tip # 1

Be Prepared Have a Back Up Plan


Be Prepared


Patient Selection


Patient Selection •Look for

• Isolated endothelial failure

•Pseudophakic corneal edema

•Fuchs corneal dystrophy

• Iridocorneal endothelial syndrome

•Minimal stromal edema

•Multifocal IOL

•Unhappy DSEK patients

•Avoid

•Previous vitrectomy

•Prior glaucoma surgery

•Prior keratoplasty

•ACIOL

•Need for IOL exchange


Patient Selection


Donor Cornea Selection Older is Better


Donor Cornea Selection •Donor

•Age between 65 and 75 years

•Negative serologic evaluation

•No history of prior corneal surgery

•Donor cornea

•ECC > 2500/mm2

•DTP < 12 hours

•DTS < 7 days

•S stamp


Preoperative Plan an Escape


Preoperative Inferior PI


Preoperative Inferior PI


Donor Preparation

Half is a Whole Lot Better Than Nothing


Donor Preparation

Lam FC, Baydoun L, Dirisamer M, Lie J, Dapena I and Melles GRJ. Hemi-DMEK Transplantation: Novel Method to

Increase the Pool of Endothelial Graft Tissue. Presented at The World Cornea Congress, San Diego, CA April 2015.


Donor Insertion Bubble = Trouble








Determining Donor Orientation Seeing is Believing

•S stamp

•Vision blue

•Slit beam

•Hand held

•Microscope mounted

www.slitlamp.com


Determining Donor Orientation


Determining Donor Orientation


Donor Unfolding Patience is a Virtue


Donor Unfolding


Donor Centration Patience is Still a Virtue


Donor Centration Bumping Technique


Donor Centration Interface Technique


Postoperative Management If It Ain’t Broke, Don’t Fix It


Peripheral Donor Detachment





Demystifying DMEK

Making the Transition •Although associated with a steep learning curve, DMEK offers advantages over DSEK that make it a technique worth learning

•Does not require lamellar corneal dissection

•Better visual acuity

•Lower incidence of endothelial rejection

•As many eyes with endothelial decompensation are not candidates for DMEK, the corneal transplant surgeon should be able to perform both DSEK and DMEK

Thank You For Your Attention! •[email protected]

Demystifying DMEK Disclosure Anthony J. Aldave,...

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