Standardized "no-touch" technique for descemet membrane endothelial keratoplasty

Abstract

We describe a standardized technique for "no-touch" isolated Descemet membrane transplant, ie, Descemet membrane endothelial keratoplasty (DMEK). All essential steps, including patient preparation and descemetorhexis as well as DMEK graft implantation, orientation, unrolling, centering, appositioning, and fixation, are described in detail. In the management of Fuchs endothelial dystrophy, the technique may provide a best-corrected visual acuity of 20/25 or better (≥ 0.8) in three-quarters of cases and an endothelial cell density of about 1800 to 2000 cells/mm(2) at 6 months after surgery. No-touch DMEK may therefore be a safe and effective procedure for the treatment of corneal endothelial disorders, making endothelial keratoplasty accessible to most corneal surgeons without requiring major investments while providing an unprecedented visual rehabilitation rate and outcome.