DMEK vs. DSEK
We are always trying to make ourselves better. Because of this, we challenge each other, as medical professionals, to consider every outlook on how we can improve the quality of care our patients receive. During our 2016 Symposium, Dr. Justin Schweitzer and Dr. Mitch Ibach publicly debated over the better method of treating patients who suffer from cornea disease or cornea damage. Dr. Ibach argued that the more delicate DMEK procedure gives patients the best visual acuity in their eyes in a quicker time frame. Dr. Schweitzer, on the other hand, argued that the traditional DSEK procedure involves less trips to the operating room and although visual acuity is slightly worse than with the DMEK procedure how important is this to patients that suffer with decreased visual quality from a corneal disease. Unless you are a medical professional, however, these terms can be rather confusing. Let’s break it down:
The cornea is the transparent layer at the front of your eye which light passes through to reach your retina and allow you to see. It consists of five layers: the epithelium, Bowman’s layer, the stroma, Descemet membrane, and the endothelium. While the epithelium is the surface layer, the stroma acts as a sponge to absorb fluid from the eye. The endothelium is a single layer of cells that regulate fluid amounts in the stroma. Damage to any parts of the cornea can negatively affect the overall quality of your vision.
DSEK was the first commonly used endothelial transplant for treating a damaged posterior cornea. It functions as a partial thickness corneal transplant that involves a thin piece of a donor tissue. Instead of replacing the cornea entirely, DSEK only replaces the diseased cells within it. This thin layer of cornea is made up of some stroma, Descemet membrane, and the endothelium.
DMEK is the newer alternative to DSEK, and is considered to be a more delicate procedure. The surgery itself involves the use of an extremely thin donor tissue of Descemet membrane and endothelium however, the stroma is not transplanted.
Pros and Cons
While both procedures have very high success rates and can help alleviate the complications that come with a damaged or diseased cornea, their results vary. Two of the major differences highlighted in recent studies show that:
- DSEK has a 9% donor tissue rejection rate at 1 year, where DMEK only has a 0.7% donor tissue rejection rate at 1 year. This means that DMEK has a better chance of working the first time the surgery is performed.
- DMEK patients, on average at 6 months post surgery obtain 20/25 vision, where DSEK typically at 6 months post surgery gives patients 20/40 vision. Although DSEK detaches at a lesser rate than DMEK, DMEK typically gives patients better vision when the surgery is successful.
No matter what option you and your doctor decide is right for you, we strive to constantly improve the quality of our care. Cornea disease and damage is very treatable, and we hope to serve you in restoring the quality of vision that you deserve.