Surgeons urged to embrace DMEK as major advance

Chicago-Descemet’s membrane endothelial keratoplasty (DMEK) is now ready for prime time and should be offered to appropriately selected patients needing a corneal graft for endothelial dysfunction because it represents the best available care, said Francis W. Price Jr., MD.

Dr. Price, of Price Vision Group, Indianapolis, presented evidence to show that compared with Descemet’s stripping endothelial keratoplasty (DSEK), DMEK provides better best-corrected visual acuity faster, along with better quality of vision, due in part to fewer posterior corneal higher-order aberrations.

In addition, DMEK significantly reduces the risk of rejection episodes. For example, in a study from Dr. Price’s center where all patients received the same steroid dosing regimen, the relative risk of immune rejection over a 2-year period was 15 times less for DMEK than DSEK.

“The difference in rejection rates is a huge benefit for patients and probably one of the biggest reasons to offer DMEK,” said Dr. Price, adding that the reduced risk of rejection also offers a potential to decrease steroid use and subsequently minimize glaucoma.

Dr. Price did acknowledge that DMEK is not for all patients with endothelial dysfunction and that it is more difficult to perform than DSEK.

“However, DMEK gets easier with practice and the problems are decreasing,” he said. “Nevertheless, surgeons have to prepare. They need proper training, proper support, and to take their time. However, patients will benefit with substantially better results.”

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