[Transplantation of endothelium and Descemet's membrane]

Nowadays, endothelial keratoplasty has become an alternative to penetrating keratoplasty (PKP) in the management of corneal endothelial dysfunction. Descemet membrane endothelial keratoplasty (DMEK) is a relatively new corneal transplantation surgery technique suited for patients with endothelial insufficiency, an increasing number of surgeons are learning the graft preparation technique and the surgery itself after seeing its excellent postoperative visual outcomes and faster rehabilitation of patients. DMEK has significant advantages in comparison with automated and manual Descemet Stripping Endothelial Keratoplasty (DSAEK/DSEK) and PKP including lower risk of immunologic graft rejection (1-2%), lower cost of the procedure, and it does not require expensive equipment such as a microkeratome or a femtosecond laser device. Another advantage is that the corneal graft tissue can be used for several recipients - e.g. when the Descemet's membrane and endothelium are used for a patient with endothelial dysfunction of the cornea, the retained stroma and epithelium can be then used for another patient with pathology of these corneal layers. Key problematic issues regarding this surgery are the technical difficulties during graft preparation and during surgery itself, however the majority of surgeons report very good results after gaining some experience. The article reviews latest clinical trials on DMEK and describes its strengths and weaknesses.