The last 15 years or so have been an exciting period of advancement in caring for patients with corneal edema, such as Fuchs’ corneal dystrophy. These conditions affect the inner layer of the cornea and are the most common reason for corneal transplantation.
Fuchs’ corneal dystrophy causes failure of the inner layer of tissue in the cornea, which is supposed to maintain the water content of the cornea. These patients experience swelling of the cornea, resulting in cloudy vision and, eventually, the need for a corneal transplant.
Before 2005, these patients had to have their entire cornea removed and replaced. While effective, the full-thickness transplant approach was somewhat problematic:
- Removing the entire cornea can compromise the structural integrity of the eye.
- Placing stitches in the cornea can cause an irregular surface, resulting in vision issues.
- Having invasive surgery carries a small amount of risk, such as rejection of the transplant.
Fast-forward 15 years. Technological advances now allow us to offer patients a less invasive corneal transplant procedure known as DMEK, or Descemet’s membrane endothelial keratoplasty.
What is DMEK?
Also known as partial-thickness transplantation, DMEK is a microsurgery technique. Surgeons use miniaturized instruments, advanced imaging, and special microscopes to guide them to the diseased corneal tissue layer, which is approximately as thin as a sheet of plastic wrap.
The DMEK technique allows eye surgeons to remove and replace only the failed corneal tissue rather than the entire cornea. Compared with traditional surgery, patients who undergo DMEK typically experience:
● Faster recovery
● Better vision after recovery
● Fewer surgical risks, including rejection
DMEK is a team procedure
Offering DMEK requires more than a skilled eye surgeon like those of us in the Department of Ophthalmology at UT Southwestern. Patients need a team of providers to get the best results. Our eye surgeons meet regularly to review patient cases and ensure every person gets the most appropriate therapy, surgical or otherwise. Recommending procedures has become more selective over the last decade.
We partner with UT Southwestern Transplant Services to gather and sustain donor corneal tissue. What’s remarkable is that the transplant team loads the donor tissue into special devices so it is ready to go and easy to transplant the moment a patient is prepped for surgery. Their proactive approach has helped simplify and improve our surgical process.
A major part of our transplant program is reviewing patient outcomes data, particularly when we use advanced techniques like DMEK. Reviewing outcomes from traditional surgical approaches as well as DMEK helps us determine whether a technique is beneficial, or we need to develop something new.
We have thorough discussions with every patient before and after surgery. We talk with them about our human genetics laboratory. Over the years, patients and their families have helped us learn a lot about eye disease processes through feedback and sharing a blood sample for genetic studies. With that knowledge, we’re developing new ways to prevent and treat cornea conditions.
What’s next in corneal transplant technology?
We are working to prevent the progression of Fuchs’ corneal dystrophy and other eye diseases at the molecular level. The treatment has exciting possibilities.
The goal is to help more patients avoid or delay corneal transplant surgery. This therapy is still in the research phase, and we hope that in five to 10 years we can release it for clinical use.
Every procedure and research study we do has the same overarching goal: improving our patients’ lives. If vision issues make it difficult to read, drive, or do other daily tasks, it might be time to consider surgery or another therapy and return to a higher quality of life.