Descemet membrane endothelial keratoplasty (dmek): surgical technique, results and complications

• Autores: I. Dapena
• Directores de la Tesis: G.R.J. Melles (dir. tes.), Jorge Luciano Alió Sanz (dir. tes.)
• Lectura: En la Universidad Miguel Hernández de Elche ( España ) en 2012
• Idioma: español
• Tribunal Calificador de la Tesis: Gernot Duncker (presid.), Jaime Javaloy Estañ (secret.), Rafael Ignacio Barraquer Compte (voc.), Miguel Ángel Teus Guezala (voc.), Angel Ramón Gutiérrez Ortega (voc.)
• Materias:
  • Ciencias médicas
    • Ciencias clínicas
      • Oftalmología
    • Cirugía
      • Cirugía ocular
      • Cirugía de los trasplantes
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• Resumen

  • Historically endothelial disorders have been treated with penetrating keratoplasty, a technique by which the recipient diseased cornea is replaced with a full-thickness sutured corneal graft. In the last decade, different "endothelial keratoplasty" techniques have been described in order to transplant a non-sutured posterior button with endothelium through a small corneal incision, avoiding the undesired complications of penetrating keratoplasty such as: more vulnerability to ocular trauma, high astigmatism, unpredictable refraction results and a long and slow visual rehabilitation.

    Even though the earliest described techniques for endothelial keratoplasty [Deep lamellar endothelial keratoplasty (DLEK) and Descemet stripping (automated) endothelial keratoplasty (DS(A)EK)] already improved considerably penetrating keratoplasty clinical outcomes, they still didn't achieve the maximal visual potential of the eye due to the transplantation of a thicker posterior layer composed of stroma, Descemet membrane and endothelium, that somehow altered the visual performance of the eye's optical system. Furthermore, as in most posterior diseases only Descemet membrane and the endothelium are generally affected, to perform an isolated transplantation of those layers would be the most adequate and effective anatomically. Thus, endothelial keratoplasty was refined into a new procedure named "Descemet membrane endothelial keratoplasty" (DMEK), i.e. the first standardized procedure that allowed the transplantation of an isolated donor Descemet membrane with its endothelium successfully. The description of this new technique, and the assessment and evaluation of the results, complications, surgical associated aspects and the new perspectives of the subject, has been the purpose of this thesis.