What's Ahead in Cornea

American Academy of Ophthalmology 2013

Christopher J. Rapuano, MD; Amir A. Azari, MD


December 09, 2013

Editorial Collaboration

Medscape &

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In This Article

DMEK: Past and Present

Christopher J. Rapuano, MD: Hello. I am Dr. Christopher Rapuano, Chief of the Cornea Service at Wills Eye Hospital in Philadelphia. Welcome to Medscape Ophthalmology Insights, coming from the American Academy of Ophthalmology (AAO) meeting in New Orleans. This is part of a series of commentaries produced in cooperation between Medscape and Wills Eye Hospital.

Joining me today is Dr. Amir Azari, Assistant Professor on the Cornea Service at Wills Eye. Today we will be discussing some of the hot topics in cornea and external disease presented at this year's meeting.

One of the more interesting topics coming into vogue is Descemet's membrane endothelial keratoplasty (DMEK) surgery. What are your thoughts on DMEK, past and present, and where we are going?

Amir A. Azari, MD: It is a relatively new procedure that a lot of people are converting to. You are replacing a smaller piece of tissue, which potentially results in better visual acuity. Not only that, it can produce better quality and quicker recovery of vision. Many people are finding out that there is a lower rate of rejection with DMEK than with Descemet's stripping automated endothelial keratoplasty (DSAEK). Many of these advantages are also seen with ultrathin DSAEK surgery.

Dr. Rapuano: Normally when DSAEK is done, you take a microkeratome or a laser and shave off about 80% of the cornea. With ultrathin DSAEK, you can either increase that amount to 90% or 95%, or you can take a pass once and then another to get thinner tissue. One of the disadvantages of ultrathin DSAEK is that sometimes you take off too much tissue and you perforate, and then that tissue is no good anymore.

Dr. Azari: With ultrathin DSAEK, the tissue is much easier to manipulate and potentially it is an easier procedure to do, with benefits similar to DMEK surgery.

Dr. Rapuano: The advantage is that you get many of the benefits of DMEK without the difficulty of DMEK.