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Review
. 2025 Feb 14;10(1):10.
doi: 10.1038/s41536-025-00396-0.

Advancements in bioengineering for descemet membrane endothelial keratoplasty (DMEK)

Sarah Barbara Zwingelberg  1 , Gizem Karabiyik  2 , Paul Gehle  3 , Melanie von Brandenstein  3 , Sabina Eibichova  4 , Christian Lotz  4   5 , Florian Groeber-Becker  6   5 , Daniel Kampik  7 , Ula Jurkunas  8 , Gerd Geerling  6 , Gregor Lang  9
Affiliations
Review

Advancements in bioengineering for descemet membrane endothelial keratoplasty (DMEK)

Sarah Barbara Zwingelberg et al. NPJ Regen Med. .

Abstract

Corneal diseases are the third leading cause of blindness worldwide. Descemet's Membrane Endothelial Keratoplasty (DMEK) is the preferred surgical technique for treating corneal endothelial disorders, relying heavily on high-quality donor tissue. However, the scarcity of suitable donor tissue and the sensitivity of endothelial cells remain significant challenges. This review explores the current state of DMEK, focusing on advancements in tissue engineering as a promising solution to improve outcomes and address donor limitations.

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Conflict of interest statement

Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1. Schematic representation of the multifactorial genesis of Fuchs endothelial corneal dystrophy (FECD).
Created by S. Zwingelberg with Biorender.com.
Fig. 2
Fig. 2. Schematic overview of Descemet Membrane Endothelial Keratoplasty (DMEK) procedure versus Descemet Stripping (Automated) Endothelial Keratoplasty (DS(A)EK).
Created by S. Zwingelberg with Biorender.com.
Fig. 3
Fig. 3. Schematic overview of direct and indirect alloantigen recognition in corneal transplantation.
Created by S. Zwingelberg with Biorender.com.
Fig. 4
Fig. 4. Schematic overview of Descemet Membrane Endothelial Keratoplasty (DMEK) and the anterior chamber associated immune deviation (ACAID).
Created by S. Zwingelberg with Biorender.com.
Fig. 5
Fig. 5. Step-by-step procedure of DMEK.
a Circular rhexis of the peripheral Descemet membrane and staining with trypan blue followed by lifting of the Descemet edge. b Separation of the Descemet membrane using two forceps. c Trephination with an 8-mm trephine. d, e Placement of graft markings for intraoperative orientation using a 1 mm trephine (green arrows). f Peeling off the graft. g, h Loading the graft into the injector cartridge. i Making incisions. j Spreading the iridotomy with vitreous scissors. k Descemetorhexis. l Insertion of the graft. m Unfurling of the graft. n Verification of graft markings (green arrows). o Injection of the air bubble. p Filling with 20% sulfur hexafluoride (SF6) gas. (With the kind using permission of Prof. Dr. med. Claus Cursiefen and Prof. Dr. med. Björn Bachmann, University Hospital of Cologne, Department of Ophthalmology, Cologne, Germany).
Fig. 6
Fig. 6. Schematic overview of the advantages of Descemet Membrane Endothelial Keratoplasty (DMEK).
Created by S. Zwingelberg with Biorender.com.
Fig. 7
Fig. 7. Schematic overview of the requirements for Descemet Membrane Endothelial Keratoplasty (DMEK).
Created by S. Zwingelberg with Biorender.com.
Fig. 8
Fig. 8. Schematic overview of recent developments and future directions for Descemet Membrane Endothelial Keratoplasty (DMEK).
Created by S. Zwingelberg with Biorender.com.
Fig. 9
Fig. 9. Schematic overview of Selective cell isolation for cell culture in vitro.
Created by S. Zwingelberg with Biorender.com.
Fig. 10
Fig. 10. Model of 3D-bioprinting for engineering of artificial corneal structures (From: Isaacson A, Swioklo S, Connon CJ.
3D bioprinting of a corneal stroma equivalent.
See this image and copyright information in PMC

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