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Looking at a new technique to prepare and transplant endothelial grafts usinf subendothelial air injections to separate donor Descemet and endothelium from overlying stroma.
For this reason Descemet Stripping Automated Endothelial Keratoplasty (DSAEK) was developed and in recent years it has gained widespread popularity. With this procedure the recipient cornea is maintained, with the exception of the complex Descemet membrane and endothelium, which are removed from the central part (usually 9 mm in diameter) of the posterior corneal surface. The donor graft consists of a thin lamella (usually between 100 µm and 200 µm in thickness) of deep stroma carrying the donor Descemet membrane and endothelium and is attached to the recipient cornea by means of an air bubble. Although cornea clarity is re-established by DSAEK in a relatively short period of time, the resulting stromal interface is considered by some authors a limiting factor for final visual acuity (VA).
From DSAEK to DMEK
To date, several technical problems relating to Dr Melles's technique have limited the popularity of DMEK among corneal surgeons. In particular, waste of donor tissue when detaching Descemet from overlying stroma should be avoided, while manipulation of donor tissue during delivery and positioning should be minimized.