DMEK Surgery: What You Need to Know; In the past, surgeons have traditionally used penetrating keratoplasty (PK) to treat corneal diseases such as Fuchs’ endothelial dystrophy, pseudophakic bullous keratopathy, corneal guttata and corneal edema. While effective in restoring vision in patients with corneal diseases, the technique does result in some permanent visual side effects.
Descemet’s membrane endothelial keratoplasty (DMEK) is a newer surgical technique that offers patients a number of benefits over PK. DMEK involves replacing only the diseased inner layers of the cornea without affecting the stronger outer layers of the cornea. As a result, patients who undergo DMEK surgery may experience significantly faster visual recovery and less astigmatism than those who undergo PK surgery.
If you are considering undergoing DMEK surgery, keep reading to learn more about what you can expect before, during and after your procedure.
What Happens Before DMEK Surgery?
Prior to surgery, your ophthalmologist will perform a complete eye exam to ensure that you are a good candidate for D
The DMEK procedure is performed in an operating room. You will be given medication to help you relax and will receive general anesthesia (be put to sleep).
You will lie on your back and the surgeon will use a speculum to hold your eye open. The surgeon will place drops of topical anesthetic in your eye to numb it.
The surgeon will make a small incision less than half a centimeter at the edge of your cornea, where it meets the white of the eye. The surgeon will not need to make any sutures because this incision is so small.
The surgeon will remove the diseased corneal tissue and implant the donor tissue. To help prevent wrinkling or folding of the donor tissue, fluid may be used to gently unfold it.
The surgeon then places a soft contact lens over your cornea and closes the incision with one or two sutures, which can later be removed.
DSAEK is a corneal transplantation procedure that replaces the inner layer of the cornea. The inner layer of the cornea contains cells called endothelial cells, which are responsible for maintaining the water content of the cornea, thereby keeping it clear.
In DSAEK, only the diseased endothelial cells are replaced with healthy donor tissue. Unlike other types of corneal transplants, DSAEK does not replace the full thickness of the cornea. Instead, a thin section of donor tissue is placed on top of the patient’s existing healthy cornea.
The healthiest part of the donor tissue is used in DSAEK because only a relatively few number of donor endothelial cells (about 1/10th) are required to restore normal function to a patient’s cornea.
DMEK can be performed on patients with Fuchs’ dystrophy and pseudophakic bullous keratopathy, both conditions in which the endothelium undergoes progressive loss, leading to swelling and cloudiness. Patients with these conditions typically have very poor vision until their disease is treated with DMEK.
DSAEK, or Descemet’s Stripping Automated Endothelial Keratoplasty, is a partial-thickness corneal transplant that replaces only the diseased inner lining of the cornea (endothelium) with healthy donor tissue.
DMEK: Descemet’s membrane endothelial keratoplasty (DMEK) is a new corneal transplant technique that replaces only the diseased back layer of the cornea. This procedure has several advantages over traditional full thickness corneal transplants. The recovery time is shorter, and there is less risk of rejection or inflammation.
German pharmaceutical company Bayer has agreed to pay more than $10 billion to settle tens of thousands of cases alleging its blood-thinner Xarelto caused uncontrollable bleeding in patients, according to a person familiar with the matter.
The settlement will resolve the vast majority of lawsuits over Xarelto and would mark the largest mass tort settlement in U.S. history, said the person, who requested anonymity because they were not authorized to speak publicly about negotiations that are ongoing.
The deal follows a string of recent legal setbacks for Bayer, which acquired Xarelto through its 2018 purchase of Monsanto Co. for $63 billion. The German company’s attempt to get cases dismissed on jurisdictional grounds was dealt a blow last month when a federal judge in New Orleans rejected its argument that claims should be heard under maritime law because some patients suffered bleeding while on cruise ships or fishing boats.
Bayer shares rose as much as 4.1% on Tuesday after Bloomberg News reported that the company was nearing a settlement. The stock has fallen more than 10% this year through Monday’s close, compared with a rise of almost 3% for Germany’s benchmark DAX Index.
A Bayer spokesman declined to comment, and lawyers representing plaintiffs did not immediately respond to
What is The Success Rate of DMEK Surgery?
The success rate of DMEK surgery is very high and the outcomes are good. The chances of vision restoration are better than most other procedures, even in patients with previous failed corneal transplants.
The success rate depends on the cause of corneal blindness and the patient’s age. The younger the patient, the better the chances of success.
The success rate for DMEK is around 95% for primary transplants, but only about 70% for secondary transplants that are required after a failed previous transplant or a complicated eye condition.
The success rate of DMEK is much higher than that of DSAEK and almost comparable to that of Descemet Stripping Endothelial Keratoplasty (DSEK). DMEK is the newest, most advanced corneal transplant technique for the treatment of Fuchs’ dystrophy. This condition occurs when cells on the innermost layer of the cornea stop functioning properly, preventing the cornea from maintaining a smooth surface and clear vision.
The success rate of DMEK surgery is high, but it depends on factors such as eye health and level of damage, among others. The best way to know whether you are a good candidate for this procedure or not is to consult an expert.To find out if you are eligible for DMEK surgery or have any other questions about corneal transplants and conditions, contact Dr. Mark Whitten today for an evaluation.
DMEK surgery has a 100% success rate in improving visual acuity, but there is some risk of complications:
- Primary graft failure (where the DMEK does not take)
- Secondary failure (where the DMEK takes initially, but then fails in the following weeks)
- Graft detachment (where the graft detaches, can be partial or full)
- Erosion of Descemet’s membrane (a complication rarely seen before DMEK surgery was developed, but now occurs in about 2% of cases)
- The success rate of DMEK surgery is approximately 80-85% when there are no complications, and the graft is attached to the back of the cornea (endothelium) by a surgeon experienced in performing DMEK. In those cases where there are complications, such as detachment of the graft or staining with air bubbles (bullous keratopathy), the success rate may be lower.
- You should discuss with your eye surgeon the risks and benefits of this procedure, as well as any alternatives that are available to you.
DMEK is a delicate procedure and requires surgeons with a high level of expertise and experience.
The success rate for DMEk is approximately 90%. This includes cases where the graft is successfully implanted and the patient has excellent vision.
DMEK success rate is around 75% at 1 year, 80% at 2 years.
DMEK can be used to correct any corneal disease as long as the cornea is thick enough or transplanted with a graft. DMEK can also be done for any reason for keratoconus patients.
In the US, DMEK is not yet approved by the FDA, so it is not widely available. In Europe, however, DMEK has been done on more than 50,000 patients and its success rate has been proven.
DMEK is a relatively new corneal transplant technique that has been shown to be more effective than other, previously used techniques.
Until recently, the standard corneal transplant procedure was penetrating keratoplasty (PKP). This technique replaces the diseased cornea with a fully opaque donor cornea. With PKP, more of the transplanted tissue is rejected and less of it is integrated than with DMEK.
The success rate for DMEK has been reported as high as 95 percent. In comparison, research shows that the success rate for PKP is only about 80 percent.
Is DMEK Surgery Painful?
DMEK is not painful.
DMEK combines a number of different elements that mean you should experience a much easier recovery than you would with other forms of corneal transplantation.
After surgery, you’ll be given an eye patch and a pair of goggles to wear while you sleep. These prevent any damage being done to your eye and also help it stay moist during the night. You will feel some irritation or discomfort, but this can be controlled by medication your ophthalmologist prescribes for you.
Although DMEK surgery is painless, it is always possible that complications could occur, as with any form of surgery. However, the risk of complications is very low with the DMEK procedure.
No, DMEK is a minimally invasive surgery, and patients are not in any pain during the procedure. Patients do not need to be operated on under general anesthesia; instead, they are given only local anesthesia.
DMEK is an advanced form of DSAEK surgery, which means that it has the same basic risks as DSAEK. Pain is minimal, both during and after the surgery, due to the small incision created by the femtosecond laser.
Possible complications include:
Bleeding from the surgical site – Some blood may seep from your eye for a short time after surgery. Use pads to protect your pillow. Be careful not to rub or poke your eye.
Debris in your cornea – Your doctor may place a bandage contact lens on your eye after surgery. This lens is removed 1 week later at your post-op appointment.
Infection – You will be prescribed antibiotic drops and ointment to prevent infection. Use these drops as directed until they are gone, and use the ointment until instructed otherwise by your doctor or nurse.
It’s not terribly painful. I had a DMEK transplant in my right eye November 2015, and I wouldn’t say it was painful, but it wasn’t exactly a pleasure cruise either. The pre-op meds knock you out, so you don’t feel anything during the surgery. They put drops in your eye afterwards as well as an oral pain medication that they give you while you’re still in the ambulatory care unit after the surgery. You’re not allowed to drive yourself home due to the anesthesia, so make sure you have someone to pick you up.
is a relatively new surgical procedure that can help restore vision to people with corneal problems.
The main benefit of DMEK is an improvement in vision quality compared to other cornea transplant procedures. This is because the thin layer of cells that’s implanted typically doesn’t scar or cloud over time.
is generally considered safe, but all surgeries carry some risks. There are a few possible complications and side effects associated with
You may feel some pain after surgery, but most patients find they can manage it with prescription pain medication. You’ll also be given antibiotics and anti-inflammatory eye drops to help prevent infection and reduce swelling.
It’s normal to have watery eyes and blurry vision for several days after surgery, but it should clear up within a week.
If your tear ducts aren’t producing enough tears, you may be prescribed artificial tears or other lubricating eye drops for a few weeks after surgery.
The cornea is the clear, protective window covering the front of the eye. A corneal transplant or “keratoplasty” is a surgical procedure in which a damaged or diseased cornea is replaced by healthy donor tissue.
The type of surgery performed depends on the extent and location of the damage to the cornea. Standard full-thickness penetrating keratoplasty (PKP) has been replaced by other techniques where only part of the cornea is replaced. These include:
Anterior lamellar keratoplasty (ALK) — replaces only the front layers of the cornea
Endothelial keratoplasty (EK) — replaces just the back layers of the cornea along with part of Descemet’s membrane; this procedure is also known as DSAEK, DMEK and DLEK
Descemet’s stripping automated endothelial keratoplasty (DSAEK) — similar to EK, but without part of Descemet’s membrane being replaced
A two-piece ink-cartridge system, HP’s 1610xi offers expandable memory and a suite of business software. It’s a solid printer for a small office, but should you buy it?
We weren’t kidding when we said the HP Photosmart Premium All-in-One (C310a) was one of the most feature-rich printers we’ve ever seen. It has a sleek design, superior output quality, and wireless connectivity. In short, it’s a premium multifunction printer. That said, it’s not for everyone: Its high price tag makes it better suited to small businesses than home offices.
The Photosmart Premium looks like any other all-in-one printer — and in many ways, it is.