Corneal transplantation, particularly DMEK surgery, presents an array of potential risks that require careful consideration. Understanding and mitigating these risks are paramount to ensuring optimal patient outcomes and safeguarding against complications. Let's delve into the various risk factors associated with DMEK surgery and how they can be effectively managed:

1. Graft Detachment:

Graft detachment is a primary concern in the early postoperative period.
Immediate post-surgery examination and patient education on activities to avoid are crucial in minimizing the risk of detachment.

2. Corneal Edema:

Corneal edema is common post-surgery and may persist, particularly in patients with specific preoperative factors.
Close monitoring and potential OCT imaging may be necessary to assess tissue adhesion and resolve persistent edema.

3. Endophthalmitis:

Although rare, endophthalmitis is a serious complication that requires prompt treatment.
Measures such as requesting Amphotericin B in the storage media of transplant tissue can help mitigate the risk of fungal contamination.

4. Retinal Detachment:

While rare, retinal detachment may occur, especially in cases with pre-existing severe corneal edema.
Vigilant monitoring and early intervention are essential to prevent vision-threatening complications.

5. Bleeding:

Intraoperative bleeding is more commonly encountered and can be minimized with careful surgical technique.
Patient education on normal postoperative occurrences, such as subconjunctival hemorrhage, is important for reassurance.

6. Need for Repeat Surgery:

Skilled surgical technique and patient education on postoperative precautions can reduce the likelihood of repeat surgery.
Identifying and addressing patient-contributed factors early on can help prevent the need for additional procedures.

7. Glaucoma:

Topical steroid use post-surgery may lead to increased intraocular pressure.
Close monitoring and consideration of alternative steroid options are crucial in managing glaucoma risk.

In conclusion, while DMEK surgery offers remarkable benefits, thorough risk assessment and management are essential components of ensuring successful outcomes. By understanding these risks and implementing appropriate measures, surgeons can navigate challenges effectively and provide patients with the best possible care.

For an in depth discussion of the risks associated with DMEK surgery and how to manage them, enroll in our online course "The Seven Minute DMEK."

The Seven Minute DMEK

Heather Skeens, MD, CFMP
Founder, BellaSee™ Education