DR. MADHURA CHANDRATREYA

, Dr. ANITHA VENUGOPAL

Abstract

Descemet membrane endothelial keratoplasty (DMEK) is the only surgical procedure that provides a true anatomic exchange of diseased endothelium and Descemet membrane with healthy donor tissue. DMEK has a steep learning curve and requires surgical skills entirely different from DSEK. Every DMEK operation is an exercise in problem solving. The hurdles faced by a surgeon novice to DMEK are tissue preparation, possibility of graft efflux while insertion, incorrect insertion of the graft, graft unfolding and possibility of rebubbling. Graft preparation and graft unscrolling and centering are the major rate limiting steps for majority of the surgeons in DMEK surgery. This video takes you through the steps of DMEK procedure combined with phacoemulsification in a small pupil and the intraoperative difficulties faced by the surgeon and suggests techniques to successfully manage and overcome the possible complications at each step, and improve patients’ visual outcome.