LAMELAR CORNEAL TRANSPLANTATION: DMEK, DESAEK or DALK

Specialists in DMEK, DSAEK or DALK techniques in Madrid for precise corneal transplants

LAMELLAR AND PENETRATING CORNEAL TRANSPLANTATION

Mainly, there are two groups of corneal transplants, the lamellar corneal transplant, in which only the affected layers of the cornea are replaced. For this transplant the DMEK, DSAEK and DALK techniques and, on the other hand, the penetrating transplant is an ideal alternative when all the corneal layers are damaged.

The cornea is made up of five layers:

Epithelium: is the outermost layer of the cornea, responsible for protecting the cornea. This one if it regenerates.
Bowman's membrane.
Stroma: thick layer of the cornea, located in the centre of it.
Descemet's membrane
Endothelium: monolayer of cells that covers the back of the cornea. These cells do not regenerate, so the damaged area is covered by nearby cells.

WHAT LAMELLAR CORNEAL TRANSPLANTATION TECHNIQUES EXIST?

DALK - Deep anterior lamellar keratoplasty (Deep Lamellar Anterior Keratoplasty).

Partial corneal transplant in which the stroma of the patient is replaced by a healthy one, thus maintaining the Descemet’s membrane and the endothelium, which means the possibility of rejection is lower.

The anterior lamellar corneal transplant is especially indicated in cases in which the endothelium is healthy, but nevertheless the anterior part of the cornea is damaged. For example:

Risks of this technique:

The risks that can arise in this technique are:

Descemet's membrane perforation (posterior layer of the cornea), whose function is to prevent the corneal tissue from deforming by distributing the ocular tension uniformly.
Opacification between the corneal tissue of the donor and the recipient. Although thanks to the femtosecond laser this risk has been significantly reduced thanks to its greater precision.
Greater surgical complexity than a penetrating transplant.

Benefits of this technique:

On the other hand, this technique has multiple benefits:

By retaining the endothelium, the posterior rejection of the graft is also reduced.
Reduction of the risk of cataract or glaucoma thanks to a less durable treatment with corticosteroids.
Reduction of the risk of intraocular infection and expulsive haemorrhage due to the fact that the intervention takes place in a closed chamber.
Quick visual recovery.
Less rejection in the patient.
Less induced astigmatism.

1.- DSAEK Technique

In the transplant of corneal endothelium with the DSAEK technique, only the endothelial cell layer is substituted, together with a thin layer of corneal stroma.

It presents a lower risk of rejection than with a penetrating transplant.

2.- DMEK Technique

In the transplant of corneal endothelium using the DMEK technique, only the cell layer is transplanted. This technique is usually used in ocular diseases such as Fuchs endothelial dystrophy, in which there is an alteration of the endothelium.

It presents a high success rate.

Benefits of these techniques:

The endothelial tissue is introduced through a small incision that does not require stitching.
Reduction of patient recovery. After a short resting time after the intervention, you can go home.
Minimal induced astigmatism.
Reduction in patient recovery from a penetrating transplant.
In case of failure, it is easier to replace the donor disk.
Lower risk of rejection than with a penetrating transplant.
Reduction of the risk of intraocular infection and expulsive hemorrhage due to the fact that the intervention takes place in a closed chamber.
All nerves of the cornea are preserved, avoiding dryness or loss of sensitivity.

WHAT IS SURGERY LIKE FOR ANTERIOR AND REAR CORNEAL TRANSPLANTATION?

Anterior corneal transplant

A small incision is made near the edge of the cornea.
Injection of air to create an internal bubble.
The diseased stroma is removed.
Substitution for a healthy one.
It is stitched.

Posterior corneal transplant

A small incision is made near the edge of the cornea.
Removal of the damaged cell layer.
Next, a thin layer of a donor's cornea is inserted.
With an air bubble, the new layer is pressed into place.
After a few days, the eye absorbs that bubble and the cells remain in the right place.