Descemet membrane endothelial keratoplasty (DMEK) is a partial-thickness corneal transplant that replaces only the diseased endothelial layer and its thin supporting membrane. It is used mainly for conditions such as Fuchs’ endothelial dystrophy.
How DMEK Is Performed
The surgeon removes the patient’s damaged endothelium through a small incision and inserts a very thin donor scroll containing healthy endothelial cells. An air or gas bubble is used to press the graft against the back of the cornea so it can adhere.
- Requires precise surgical technique due to the fragility of the graft
- Usually performed under local anaesthetic with sedation
- The bubble position is checked carefully after surgery
- Occasional “rebubbling” may be needed if the graft partially detaches
Results and Aftercare
DMEK often provides excellent visual quality with quicker recovery and less induced astigmatism than full-thickness grafts. Patients use steroid and antibiotic drops for months to prevent rejection and infection.
- Vision may improve substantially within weeks but can continue to refine over months
- Rejection episodes are less common but still possible and need urgent treatment
- Regular follow-up monitors graft clarity, pressure, and corneal thickness
- Long-term prognosis is generally good when underlying disease is controlled
