We Offer Medical Education
DSEK/DSAEK and Introduction to DMEK
Overview and Statement of Need
Statement of Need
For 50 years, penetrating keratoplasty (PK), or replacement of the full thickness of the cornea, was the standard of care for patients with corneal endothelial disease. In this Advanced Cornea Course, corneal specialist Dr. Francis W. Price, Jr., teaches a more targeted approach of replacing just the diseased layer of the cornea, rather than the full thickness.
DSEK / DSAEK: Descemet’s Stripping Endothelial Keratoplasty (“DSEK”) – also known as Descemet’s Stripping Automated Endothelial Keratoplasty (“DSAEK”)—replaces only the endothelial cell layer of the cornea with a thin partial thickness of the posterior stroma from the donor cornea. It produces a stronger wound post op, more rapid healing (one to three months instead of one to two years), and more predictable results with little or no change in refraction. Eye banks now provide pre-cut tissue, making DSEK more accessible than ever.
DMEK: Descemet’s Membrane Endothelial Keratoplasty (“DMEK”) is the newest iteration of endothelial keratoplasty. It replaces only Descemet’s membrane and endothelium, and leaves the patient’s cornea closer to its original condition than any other transplant technique. DMEK has some similarities to DSEK/DSAEK. But it also has number of dramatic differences in donor preparation, manipulation in the eye and post operative care. Benefits of DMEK include: 2.8 mm or smaller corneal incisions; no increase in corneal thickness; no refractive shift from donor graft; ability to pre-operatively plan astigmatism management to reduce or eliminate pre-operative cylinder; and no changes or guesses for “fudge factors” with IOL calculations. DMEK can be done without purchasing expensive equipment (microkeratome and anterior chamber are not required). Surgery requires only hand instruments and IOL injectors. Eye banks are developing methods to provide pre-cut tissue for DMEK.
DSEK/DSAEK and DMEK are widely preferred for treating Fuchs’ endothelial dystrophy, bullous keratopathy, iridocorneal endothelial syndrome and failed PK. They routinely are performed with topical anesthesia.
Dr. Price presents lectures and slides, supervises wet labs, conducts postoperative examinations and performs live surgeries. There is a strong emphasis in the course on technique and avoidance of complications.
Educational Objectives
Training format consists of didactic, wet labs, live surgeries, observation of post-op patients, presentation of difficult and challenging cases, and lively “What would you do?” questions and answers. At the conclusion of this two-day course, participants should be able to:
- Describe current concepts and rationale for endothelial keratoplasty
- Summarize comparisons to penetrating keratoplasty
- Communicate the benefits of endothelial keratoplasty surgery
- Differentiate options for patients who could benefit from endothelial keratoplasty surgery
- Demonstrate proper use of instruments and equipment for endothelial keratoplasty
- Summarize the efficacy of anesthesia options
- Perform endothelial keratoplasty surgery using the step-by-step system provided in the activity
- Demonstrate proper management of dislocations
- Demonstrate understanding of how to manage and reduce complications
- Apply evidence-based best practices for post operative care
