Descemet’s Membrane Endothelial Keratoplasty (DMEK)
Descemet’s Membrane Endothelial Keratoplasty (DMEK) is a new corneal transplantation procedure that involves precisely replacing the inner one percent of the cornea, Descemet’s membrane, and the associated endothelial cells.
DMEK is used to reduce swelling and restore vision in patients with endothelial disorders, such as Fuchs’ endothelial dystrophy, failed previous corneal transplants and bullous keratopathy.
DMEK involves peeling an extremely thin layer of diseased endothelial cells, along with the attached membrane, from the back of a patient's cornea. Then, an equally thin membrane from a donor cornea, with healthy endothelial cells, is inserted and positioned with a gas bubble in order to replace the patient’s diseased tissue. After the surgery, a patch is placed on the eye. The patient is required lie down on his or her back and look at the ceiling as much as possible for the first 24-48 hours. The patient needs to come back for a follow-up appointment the next day.
While DMEK has not yet been widely adopted, the procedure shows promise as the next standard-of-care for many indications of endothelial keratoplasty. In contrast to other partial thickness corneal transplant procedures, such as Descemet’s Stripping Automated Endothelial Keratoplasty, DMEK replaces only the diseased tissue without need for additional or redundant tissue, which allows for a more precise and anatomically correct approach. As a result, DMEK has demonstrated lower risk of rejection, faster recovery, and better vision (a higher percentage of patients achieve 20/20 vision) than prior forms of corneal transplant.
Several physicians at Mass. Eye and Ear are among a select group of ophthalmic surgeons on the East Coast who have DMEK surgical expertise:
- Peter Veldman, M.D.
Dr. Veldman has expertise in lamellar or partial thickness corneal transplantation including DMEK, DSAEK, DALK, and Penetrating Keratoplasty (PK). Dr. Veldman pursued specialized training in the lamellar (partial thickness) corneal procedures as a Cornea Fellow at Devers Eye Institute in Portland, Oregon, training under the direction of two of the world’s leading experts in DMEK. Dr. Veldman’s research during fellowship focused on the introduction of, and outcomes using, a stromal sided S-stamp in DMEK, which has to date eliminated upside down DMEK graft implantation, a primary cause of graft failure in DMEK. Dr. Veldman currently heads a randomized surgical trial at Mass. Eye and Ear comparing suturing techniques in the repair of traumatic corneal lacerations.
- Ula Jurkunas, M.D.
Dr. Jurkunas performs corneal and refractive surgery at Mass. Eye and Ear and conducts basic science research on Fuchs’ Endothelial Corneal Dystrophy and stem cell transplantation. She is one of the highest volume refractive and transplant surgeons at Mass. Eye and Ear, and was first at the hospital to perform DMEK for corneal edema and Fuchs’ dystrophy, alongside Robert Pineda II, M.D. At Schepens Eye Research Institute of Mass. Eye and Ear, the Jurkunas Laboratory is working to develop better treatments and preventatives for Fuchs’ dystrophy, a disease that accounts for over 10,000 corneal transplants each year in the United States. Dr. Jurkunas, who also is Co-director of the Harvard Medical School Cornea Center of Excellence, was recently awarded a $2.5 million grant from the National Eye Institute of NIH to study “The role of oxidative stress in the pathogenesis of Fuchs’ Endothelial Corneal Dystrophy.”
- Roberto Pineda II, M.D.
Dr. Pineda is a highly experienced ophthalmologist and surgeon with expertise in corneal disorders, external disease, refractive surgery, and ocular trauma. As Director of Refractive Surgery on the Cornea Service at Mass. Eye and Ear, he specializes in laser vision correction, corneal surgery, and cataract surgery. Most of his patients have complex cases and are referred to him after second or third opinions, or re-operations. In June 2014, Dr. Pineda performed the first DMEK surgery at Mass. Eye and Ear, alongside Dr. Jurkunas. He also performed the first successful cornea transplant with donor endothelial tissue preloaded by an eye bank and was one of the first surgeons in New England to perform laser-assisted cataract surgery with the femtosecond LensSx® laser.
- Kathryn Hatch, M.D.
Dr. Hatch is an accomplished surgeon with experience in the most advanced corneal transplantation surgery procedures. These include DMEK, Descemet’s Stripping Automated Endothelial Keratoplasty (DSAEK), Deep Anterior Lamellar Keratectomy (DALK), and Intralase Enabled Keratoplasty (IEK), and she was the first eye surgeon in New England to perform IE-DALK. Dr. Hatch also specializes in all-laser refractive surgery, refractive laser-assisted cataract surgery and premium intraocular lens surgery, as well as corneal crosslinking and intrastromal corneal ring segments (Intacs®) for keratoconus and dry eye. Additionally, Dr. Hatch is an investigator in several clinical trials including a large multi-center phase 4 trial studying collagen crosslinking for keratoconus, as well as a trial studying medications to reduce endothelial cell loss in cataract surgery.
- Joseph Ciolino, M.D.
Dr. Ciolino specializes in corneal transplantation, including DMEK and keratoprosthesis. As a clinician scientist, his research focuses on translational projects such as keratoprosthesis and ocular drug delivery. He is working with colleagues at Boston Children’s Hospital and MIT to develop a sustained-release, drug-eluting contact lens, capable of delivering various pharmaceutical agents, such as antibiotics, antifungals, and glaucoma medication. Dr. Ciolino completed a two-year fellowship in the Cornea, Refractive Surgery and External Disease Service as a recipient of the nationally recognized Claes Dohlman Fellowship Award before joining the Cornea Service at Mass. Eye and Ear. He was recently awarded a four-year $2.77 million grant from the Department of Defense-US Army Medical Office for his project, “Vision restoration with a collagen crosslinked Boston Keratoprosthesis unit.”
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