DMEK is a revolutionary corneal transplant procedure that offers rapid recovery and sharp vision. Trust our expert cornea specialists to restore your vision with this minimally invasive solution.
DMEK is a state-of-the-art, partial-thickness corneal transplant designed to treat a cloudy cornea caused by diseases like Fuchs' dystrophy. Our cornea specialist uses this advanced, minimally invasive procedure to replace only the single, damaged cell layer of your cornea, resulting in faster visual recovery, sharper vision, and a lower risk of rejection compared to older transplant methods.
The cornea is the clear, dome-shaped window at the front of your eye that is responsible for focusing light. To stay clear, it relies on a single, delicate layer of cells on its inner surface called the endothelium. These cells act like tiny pumps, constantly removing fluid from the cornea. When the endothelial cells stop working properly, the cornea becomes water-logged, swollen, and cloudy, causing blurred vision.
Descemet’s membrane is a thin, flexible layer located between the endothelial cells and the stroma of the cornea. It plays an essential role in the structural integrity of the cornea and in maintaining its clarity by functioning with the endothelial layer to pump excess fluid out of the cornea. DMEK, which stands for Descemet's Membrane Endothelial Keratoplasty, is a highly advanced corneal transplant procedure. Unlike a traditional full-thickness transplant, DMEK is a partial-thickness surgery. Our cornea specialist precisely removes only the diseased inner lining (the Descemet's membrane and endothelium) and replaces it with an ultra-thin layer of healthy donor tissue. The new tissue is held in place with a temporary air bubble, not stitches.
The donor tissue used in DMEK is incredibly thin—about 10-15 microns, or four times thinner than a sheet of paper. Once this new, healthy layer of endothelial cells is in place, it immediately begins its job of pumping fluid out of the cornea. As the swelling goes down, the cornea gradually becomes clear again. This allows light to focus properly, restoring the sharp, clear vision that was lost due to corneal clouding.
DMEK (Descemet Membrane Endothelial Keratoplasty) is a minimally invasive corneal transplant procedure that replaces only the diseased innermost layers of the cornea. This innovative approach offers rapid visual recovery, extraordinary visual outcomes, and reduced risks compared to traditional full-thickness transplants.
Patients typically experience a quicker return to clear vision, with many regaining near-optimal visual acuity within 1–3 months. The streamlined nature of DMEK means that the healing process is faster, allowing for a swift restoration of daily activities.
By replacing only the Descemet membrane and endothelium through a tiny incision (often 2–3 mm), DMEK preserves the healthy corneal tissue. This flapless approach avoids the need for stitches, minimizes tissue disruption, and maintains the natural curvature of the cornea.
DMEK boasts one of the lowest graft rejection rates among corneal transplants, significantly reducing the risk of immune complications. Its minimally invasive nature and precise placement with an air bubble pressure also help lower the risks of infection and post-surgical astigmatism.
By utilizing an optimized air bubble technique for graft adhesion, while in some cases a small amount of viscoelastic may be used selectively, the procedure not only enhances intraoperative visibility but can also reduce surgical time and costs. This results in a more efficient operation with improved overall outcomes.
Since DMEK only replaces the innermost layer and leaves the vast majority of your own cornea intact, the structural integrity of your eye is preserved. This makes the eye much stronger and more resistant to injury compared to a full-thickness transplant, which involves replacing the entire central cornea. This is a critical safety advantage for our patients' long-term eye health.
DMEK is the ideal treatment for eye conditions where only the innermost endothelial layer of the cornea is damaged, while the other layers remain healthy. The most common indications include:
Patients who require DMEK typically experience a progressive worsening of their vision. Common symptoms include blurred or cloudy vision that is often worse in the morning, significant glare or halos around lights that make night driving difficult, sensitivity to light (photophobia), and a feeling of irritation or something being in the eye. Our cornea specialist can determine if these symptoms are related to endothelial dysfunction.
To determine if you are a candidate, our cornea specialist will perform a full medical and eye history and a thorough examination using a slit lamp. We will also conduct specialized tests to evaluate your endothelial cells. These may include specular microscopy to count your endothelial cells, pachymetry to measure your corneal thickness, and an anterior segment OCT to get a detailed image of your cornea's layers.
While DMEK is preferred for routine cases, an alternative procedure like DSAEK (which uses a slightly thicker graft) may be recommended for eyes with more complex anatomy. For some patients, such as those with significant endothelial dysfunction in the setting of prior vitrectomy, irregular corneal anatomy, or other complexities, DSAEK might be preferred due to its thicker graft and more predictable outcomes in these cases.
The success of DMEK surgery is highly dependent on proper post-operative positioning. Patients must be able to lie flat on their back for extended periods for the first few days after surgery to allow the air bubble to hold the graft in place. If a patient has physical limitations, such as severe back problems, or other issues that prevent them from maintaining this supine position, DMEK may not be the best choice.
Having glaucoma does not prevent you from having DMEK, but it requires special consideration. The temporary increase in eye pressure from the air bubble must be carefully managed. Our cornea specialist is highly experienced in performing DMEK in glaucomatous eyes and will make specific technique adaptations, such as creating a small opening in the iris (iridotomy) to prevent pressure spikes, to ensure a safe procedure.
While a full-thickness transplant (PKP) shows the highest long-term survival at 92% after 10 years, DMEK demonstrates excellent durability at 75% survival over the same period. More importantly, if a DMEK graft is successful after the first year, its chance of continued survival is very high. This data confirms that DMEK is a reliable, long-term solution for restoring corneal health and vision.
Any corneal transplant will experience a loss of endothelial cells over time. Studies show that DMEK patients experience about a 35% loss of cells in the first year, which is an expected part of the healing and stabilization process. While the long-term rate of cell loss may be slightly faster than with a full-thickness graft, the initial cell count is more than sufficient to keep the cornea clear for decades in successful cases.
The most common complication after DMEK is a partial graft detachment, where an edge of the graft moves slightly out of position. This is often addressed with a simple, in-office procedure called a "rebubble," where a small amount of air is re-injected into the eye to push the graft back into place. Studies show this may be needed in about 20-25% of cases. Importantly, needing a single rebubble does not negatively affect the final visual outcome.
The information presented here is based on large-scale clinical evidence and major retrospective studies. Research from Germany evaluating over 3,200 DMEK procedures confirms significant visual acuity gains, with most uncomplicated eyes reaching 20/25 vision at 12 months. This, along with other meta-analyses and randomized trials, consistently shows DMEK's superiority in visual recovery and its low rejection rates, solidifying it as the standard of care for endothelial disease.
If you're experiencing cloudy vision or other symptoms of endothelial dysfunction, contact our cornea specialist today to see if DMEK is the right procedure for you. Regain the clear vision you deserve with minimally invasive corneal treatment.
Most people notice better vision in 1 to 3 months.
You usually go home the same day.
You’ll need to spend time lying on your back after surgery to help the graft stick in place.
You’ll use antibiotic and steroid drops to help healing and prevent infection.
Regular check-ups are important to make sure the graft is healing and there are no complications.
Our Cornea specialist balances surgical complexity with desired outcomes to determine the best approach for each patient.
No. The procedure is performed with topical anesthetic eye drops that completely numb the eye, so you should not feel any pain. After the surgery, it is normal to experience some mild scratchiness or light sensitivity for a few days, but this is easily managed with the prescribed eye drops. Significant pain is not a typical part of the DMEK experience.
A successful DMEK transplant is intended to last for many decades, and potentially for the rest of your life. The long-term durability is excellent, especially in cases of Fuchs' dystrophy. You will need to use a single anti-inflammatory eye drop each day long-term to protect the graft, and regular check-ups with our cornea specialist will ensure it remains healthy.
DMEK has a very high success rate, especially in the hands of an experienced cornea specialist. The rate of successful graft attachment and clearing is over 99% in routine cases like Fuchs' dystrophy. The procedure consistently leads to significant vision improvement and high patient satisfaction, making it one of the most successful transplant surgeries performed today.
As with any surgical procedure, DMEK carries certain risks. These can include infection, graft failure, partial graft detachment (requiring rebubbling), elevated intraocular pressure from the air bubble, or difficulty in achieving optimal graft positioning. However, these complications are rare, and the procedure’s risk profile is much lower than other forms of corneal transplantation.
If you're experiencing cloudy vision or other symptoms of endothelial dysfunction, contact our cornea specialist today to see if DMEK is the right procedure for you. Regain the clear vision you deserve with minimally invasive corneal treatment.
DMEK is a cutting-edge, minimally invasive corneal transplant for cloudy vision. Find a top cornea specialist near you today!
