Descemet membrane endothelial keratoplasty (DMEK) has largely superseded DSAEK for Fuchs' endothelial dystrophy. The primary advantage of DMEK over DSAEK is:
- A Lower rate of graft detachment requiring rebubbling
- B Better postoperative best corrected visual acuity (BCVA) reaching 20/20 in > 50% of cases due to absence of stroma-induced higher-order aberrations ✓
- C Faster surgical time and easier tissue preparation
- D Complete elimination of rejection risk due to thin graft tissue
Explanation
DMEK (Descemet membrane endothelial keratoplasty) transplants only the DM and endothelial cell layer (~15 micrometers) without stromal carrier tissue. This eliminates the donor-recipient stromal interface that in DSAEK (Descemet stripping automated endothelial keratoplasty, which includes ~100-120 μm of donor stroma) introduces higher-order aberrations and interface haze. DMEK consistently achieves 20/20 or better BCVA in > 50% of cases, superior to DSAEK where only ~30% reach 20/20. The trade-offs are higher graft detachment rates requiring pneumatic rebubbling and technically more demanding tissue preparation and insertion. Rejection can still occur with DMEK but at lower rates due to the minimal amount of transplanted tissue.
Reference: Khurana Comprehensive Ophthalmology, 7th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.