Sutured Descemet Membrane Endothelial Keratoplasty in Patients With Complex Anatomy or Difficulty Positioning

At Wilmer Eye Institute, Johns Hopkins Medicine we often care for patients who’ve had complications from prior eye surgeries — complicated cataract operations, glaucoma implants, ocular trauma, or failed corneal transplants.  These patients come to us with severe corneal swelling, pain, and vision loss due to irreversible corneal endothelial damage.

These are among the most challenging surgeries in corneal transplantation.  The eye anatomy is often profoundly distorted: severe internal scarring, missing or fixed iris tissue, dislocated or absent lenses, and unstable or absent anterior chambers. Visualization is limited, graft handling is treacherous, and there’s real risk of losing the delicate transplant tissue into the back of the eye.  Even after surgery, keeping the transplant tissue attached remains a major challenge.

For years, full-thickness penetrating keratoplasty or DSAEK were the only viable options. DMEK — the most precise and minimally invasive form of corneal transplantation — was considered too risky due to high risk of graft detachment and failure.

Today, we’re pushing the boundaries by performing DMEK in eyes once considered too damaged for this approach. In this publication, we describe a novel “sutured DMEK” technique that enables successful graft attachment even in complex eyes or in patients unable to position postoperatively.  With this approach, we’ve expanded the benefits of minimally invasive corneal transplantation — faster visual recovery, better long-term vision, and lower rejection risk — to even more patients needing vision restoration.