Descemet Membrane Endothelial Keratoplasty: Evolving Surgical Techniques and Contemporary Clinical Outcomes – A Narrative Review

Downloads

Published

2026-07-31

DOI:

https://doi.org/10.56692/upjo.2026140207

Keywords:

Corneal transplantation,, Descemet membrane endothelial keratoplasty (DMEK),, Endothelial cell loss, Endothelial keratoplasty, Fuchs endothelial corneal dystrophy.

Dimensions Badge

Issue

Vol. 14 No. 02 (2026): UP JOURNAL OF OPHTHALMOLOGY

Section

Review Article

License

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

© Author, Open Access. This article is licensed under a CC Attribution 4.0 License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit https://creativecommons.org/licenses/byncsa/4.0/.

Authors

  • Fawaz Almutairi Department of Ophthalmology, IBN Sina Hospital, Shuwaikh, Kuwait

Abstract

Objective: To synthesize contemporary developments in endothelial keratoplasty, outlining the evolution from penetrating keratoplasty (PK) and DSEK/DSAEK to Descemet Membrane Endothelial Keratoplasty (DMEK), while summarizing modern surgical refinements, clinical outcomes, complication patterns, and emerging innovations.
Methods: A narrative review was conducted using PubMed and Scopus (January 2010–February 2026). Search terms included DMEK, DSAEK/UTDSAEK, posterior lamellar keratoplasty, DSO/DWEK, endothelial cell loss, graft detachment, preloaded grafts, and longterm outcomes. Eligible sources comprised randomized trials, cohort studies, large case series, systematic reviews, and techniquefocused reports. Findings were synthesized thematically due to heterogeneity in study designs and outcome measures.
Result: Across the literature, DMEK consistently provides the fastest visual recovery and best optical outcomes among endothelial keratoplasty techniques, with many eyes achieving ≥20/25 vision postoperatively. Early endothelial cell loss is substantial but stabilizes over time. Surgical innovations including preloaded P3 tissue, endotheliumin delivery, standardized notouch unfolding maneuvers, and orientation stamps have reduced intraoperative manipulation and improved reproducibility. Graft detachment remains the most frequent early complication, influenced by low early postoperative intraocular pressure, older age, diabetes, and Fuchs endothelial corneal dystrophy; however, timely rebubbling typically preserves longterm graft function. Despite progressive endothelial attrition, DMEK maintains high graft survival and low rejection rates over longterm followup.
Conclusion: Today, DMEK is considered the gold standard for endothelial replacement due to its exceptional optical quality and minimal immunologic risk. Looking forward, bioengineered endothelial constructs, cell‑based therapies, and tissue‑efficient graft formats hold promise for expanding global access and reducing reliance on donor tissue.

How to Cite

1.
Almutairi F. Descemet Membrane Endothelial Keratoplasty: Evolving Surgical Techniques and Contemporary Clinical Outcomes – A Narrative Review. UPJO [Internet]. 2026 Jul. 31 [cited 2026 Jul. 31];14(02):85-93. Available from: https://upjo.org/index.php/upjo/article/view/682

Downloads

Download data is not yet available.