DMEK graft: One size does not fit all

Area of Science:

• Ophthalmology
• Corneal Surgery
• Tissue Transplantation

Background:

• Descemet membrane endothelial keratoplasty (DMEK) treats corneal endothelial diseases like Fuchs endothelial corneal dystrophy (FECD) and pseudophakic bullous keratopathy (PBK).
• While DMEK offers advantages, graft preparation and delivery present significant challenges, particularly determining optimal graft size.

Purpose of the Study:

• To review challenges in preparing and delivering DMEK tissues of varying diameters.
• To discuss outcomes, complications, and benefits related to different DMEK graft sizes.
• To provide guidance on selecting appropriate graft sizes for specific patient cases.

Main Methods:

• Literature review focusing on graft preparation and delivery techniques in DMEK.
• Analysis of outcomes and complications associated with small versus large DMEK grafts.
• Evaluation of the impact of descemetorhexis size on graft selection.

Main Results:

• Smaller DMEK grafts are generally preferred and accepted, though larger grafts offer potential benefits.
• Larger diameter grafts are associated with increased rates of graft detachment.
• Graft size selection is critical, especially with advanced techniques like pre-loaded DMEK.

Conclusions:

• Optimal DMEK graft size selection balances benefits against risks like detachment.
• Understanding the relationship between graft size, endothelial cell count, and outcomes is essential.
• Case-specific selection of smaller or larger grafts can improve DMEK success rates.