Our collective efforts have advanced endothelial keratoplasty to the point where we can now attain a very nearly perfect anatomical replacement of the diseased endothelium and Descemet membrane with healthy donor tissue.1 To our patients, this means that we can deliver visual outcomes and rejection rates that are far superior to penetrating keratoplasty (PK) and even better than Descemet stripping automated endothelial keratoplasty (DSAEK). To the corneal transplant surgeon, it means that we have the opportunity to learn a new surgical skill set that is very different from that for DSAEK.
The procedure for Descemet membrane endothelial keratoplasty (DMEK) has many nuances that can be important for success. This chapter’s goal is to ease the learning curve of the novice DMEK surgeon by introducing the most critical details of our standardized surgical technique. It should not be considered an adequate substitute for a “hands-on” DMEK course, where one can assist an experienced DMEK surgeon at the operating microscope and gain experience in the DMEK in vitro wet lab.