DMEK complications: current treatment and recommendations

ABSTRACT

Introduction: In the last 20 years the treatment of endothelial dysfunction has evolved dramatically. Nowadays, Descemet membrane endothelial keratoplasty (DMEK) allows for an anatomical replacement of the diseased posterior corneal layers, while preserving the anterior part of the cornea. Compared with earlier endothelial keratoplasty techniques, DMEK results in faster and near complete visual recovery in most cases, while the incidence of complications is low. Technique standardization and introduction of new surgical strategies have made DMEK safer and easier to learn.

Areas covered: To achieve the best clinical results, adequate handling of postoperative complications is mandatory, as they may hinder recovery and influence postoperative outcomes. In this article we review the incidence of postoperative complications after DMEK surgery and discuss strategies for their prevention and management. Literature search was last conducted in the PubMed database in September 2017. The search was limited to English language abstracts that included terms such as DMEK, complication, graft detachment, cataract, glaucoma, rejection, graft failure, macular oedema and IOL opacification.

Expert commentary: A careful donor selection and graft preparation alongside with an adequate selection of patients and the proper prevention and management of complications would allow for a smoother surgery and better and faster postoperative outcome.

KEYWORDS:

• Descemet membrane endothelial keratoplasty
• complication
• graft detachment
• graft failure
• rejection
• IOL calcification
• IOP elevation

Acknowledgments

We would like to thank all surgeons who participated in our multicenter clinical trials on DMEK [19,21], which provided us with more comprehensive data on DMEK and its complications.

Declaration of interest

G RJ Melles is a consultant for DORC International/Dutch Ophthalmic USA and SurgiCube International. Drs. Dapena and Baydoun are consultants for DORC International/Dutch Ophthalmic USA. The other authors do not have any conflicts of interest to disclose.

Financial Disclosure

Dr Melles is a consultant for DORC International/Dutch Ophthalmic USA and SurgiCube International. Drs. Dapena and Baydoun are consultants for DORC International/Dutch Ophthalmic USA. The other authors do not have any conflicts of interest to disclose.

Additional information

Funding

This paper has not been funded.