Understanding DMEK: Standard ‘no-touch’ technique [VIDEO]

This stepwise video presentation of the standardized "no-touch" Descemet’s membrane endothelial keratoplasty (DMEK) technique is described by Gerrit R.J. Melles, MD, PhD. It is performed by his team, Isabel Dapena, MD, PhD, and Vasilios S. Liarakos, MD.

Among the steps illustrated:

• Corneal incisions

• Injection of air into the anterior chamber

• Scoring of the host Descemet’s membrane

• Removal of the host Descemet’s membrane (descemetorhexis)

• Central corneal incision

• Withdrawing the host Descemet’s membrane

• Descemet’s membrane graft

• Implantation of the graft in the anterior chamber

• Tapping on top of the cornea to unfold the graft

• Unfolding the graft-standardized “no-touch” technique

• Centering the graft by tapping on top of the cornea

• “Bubble rolling” to unfold peripheral curls

• Enlargement of the air bubble to unfold the graft completely

• Aspiration of air from on top of the graft

• Lifting the graft with air-positioning against the stroma

The air bubble remains in the anterior chamber for 60 minutes and then it is reduced.

DMEK was introduced in 2005 by Dr. Melles. Since then, the technique has evolved and has been standardized and described in detail in the literature (Arch Ophthalmol. 2011;129:88-94).

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