A corneal transplant is sight-saving surgery that allows a patient with eyesight compromised by cornea damage to have their vision restored, in some cases to 20/20. More than 44,000 corneal transplants are performed in the United States every year, making it one of the most common and successful procedures of its kind.
Advances have been made in technique and recovery, giving patients new hope in vision improvements.
New York Eye and Ear Infirmary of Mount Sinai (NYEE) is a leader in corneal transplants and, in recent years, has had great success with the latest technique called Descemet’s membrane endothelial keratoplasty (DMEK). By selectively replacing only the damaged portion of the cornea with ultra-fine donor tissue, surgeons are able to produce much better patient outcomes than other endothelial keratoplasty techniques.
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In this Q&A, Angie E. Wen, MD, a cornea specialist at NYEE, explains why this procedure is becoming more popular.
“DMEK is the latest cutting-edge surgical technique, and at NYEE, patients get the best surgical and post-operative care, not only by our surgeons but the entire OR and post-op team,” she says.
What are the benefits of DMEK corneal transplant?
The DMEK technique is revolutionary. The technique offers a low rejection rate (1 percent), faster recovery, faster and more significant improvement in vision, and less reliance on long-term use of eye drops that can cause immunosuppressive side effects. Clear vision of many patients is restored in a few months.
What is the cornea and how does it get damaged?
The cornea is the clear outer layer of your eye that is directly in front of the iris (the colored part) and the pupil. It allows light to enter your eye. The cornea provides approximately 65 to 75 percent of the focusing power of the eye. It must remain clear for there to be good vision. If it is scarred or swollen, it may result in glare or blurry vision. Cornea damage may be caused by an infection, a medical condition that leads to a thinning cornea, such as keratoconus; chronic swelling following cataract surgery; or by Fuchs Dystrophy, a genetic disorder that causes swelling.
What happens during a DMEK corneal transplant?
During the DMEK procedure, the surgeon carefully strips out the damaged Descemet’s membrane and endothelium layer of the cornea and replaces it with donor tissue that has been thoroughly screened, processed, certified, and prepared by the eye bank. The surgeon replaces the damaged corneal layer with the new micro-thin tissue that, at 10 microns, is the thickness of a strand of hair. It is then secured with a gas bubble. The outpatient procedure typically lasts approximately 30-45 minutes. Although it is a highly effective procedure, it requires a steep learning curve for the surgeon to master who must work with tissue that is so thin and delicate. Consequently, only 30-40 percent of surgeons nationwide feel comfortable performing it.
Is anyone a candidate for DMEK?
Not all patients are candidates for DMEK, including those with complex anterior segment anatomy, a previous history of retinal detachment repair, or glaucoma surgeries. In these cases, a Descemet’s Stripping Automated Endothelial Keratoplasty (DSAEK) may be a better option. Surgeons at New York Eye and Ear Infirmary are able to apply both the latest technologies of endothelial keratoplasties customized to patients’ individual anatomy and specific needs.