DSEK/DMEK - Sutureless Corneal Transplant Surgery

The Cornea is the optical window to the eye and must remain clear to achieve excellent vision. If corneal decompensation and clouding results due to damage to the Endothelium (En), it may be possible to bypass traditional corneal transplant surgery using DSEK .(Descemets Stripping and Endothelial Keratoplasty) or DMEK (Descemets Membrane Endothelial Keratoplasty), new surgical approaches to treating corneal pathology.



The most internal layer of the cornea, the Endothelium (En), a monolayer of cells, is responsible for maintaining the clarity of the entire cornea. The Endothelial monolayer is attached to Descemets Membrane (De). If the Endothelium is damaged, the cornea will become edematous and cloudy, compromising acuity.

 

 

By removing the damaged Endothelium (and the supporting Descemets Membrane) and replacing it with healthy donor tissue (shown below as a blue layer), the clarity to the cornea can be restored more quickly and without refractive power changes to the eye when compared to traditional full thickness corneal transplant surgery.

 

DSEK requires an Artificial Chamber and an Automated Microkeratome to prepare the donor tissue (DMEK utilizes a simpler method to harvest the tissue). The initial step in DSEK begins with applying a protective viscoelastic coating to the Artificial Chamber as shown below:


 

The donor tissue, consisting of the cornea and some scleral rim, is transferred to the Artificial Chamber.

 

 

A locking ring is then applied to the Artificial Chamber to secure the donor tissue, followed by a second ring with a track.
 



 

The Automated Microkeratome is engaged in the track and activated, traversing the donor and removing a thick disk of corneal tissue. The donor tissue that remains is thinned considerably.


 

Next, the residual donor tissue which has been thinned is trephined, resulting in an 8-9 mm disk of Endothelial tissue (Endothelium, Descemets Membrane, and a small section of Stroma) which will be implanted into the patient's eye.

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