Feb 20, 2025 — Michael Szkarlat, Senior Partner Development Director
Disclaimer: Medical information is not medical advice—read our disclaimer.
The February 2025 Eversight Academy webinar set the stage for an exciting year of discussions on advancements in corneal care. Dr. Christopher Sales, associate professor of ophthalmology at the University of Iowa Department of Ophthalmology and Visual Sciences, led an in-depth session on Endothelium-in Descemet Membrane Endothelial Keratoplasty (DMEK) and its application in complex eyes. Known for his expertise in minimally invasive corneal transplantation, Dr. Sales provided a comprehensive exploration of this evolving technique, breaking down its mechanics, challenges and potential advantages over traditional methods.
The evolution of DMEK: Understanding the shift
DMEK has grown in popularity over the past decade, particularly for treating Fuchs dystrophy. While conventional DMEK techniques, such as endothelium-out methods, have been widely used, Dr. Sales focused on a newer approach—Endothelium-in pull-through DMEK. This method, he explained, leverages the natural recoil forces of the corneal tissue to facilitate graft unfolding, rather than relying on frictional forces and external manipulation.
Endothelium-in DMEK: A complex yet promising approach
The webinar delved into the intricacies of Endothelium-in DMEK, with Dr. Sales sharing surgical videos demonstrating how the tissue, when pulled through, naturally unfurls within the anterior chamber. He contrasted this with the conventional Endothelium-out, tap-technique DMEK, where surgeons manually tap the cornea to unfold the graft.
While the technique shows promise, it is not without challenges. Dr. Sales described the procedure as “ergonomically complex” due to the intricate hand positioning and coordination required. He emphasized that mastering Endothelium-out DMEK is essential before incorporating Endothelium-in DMEK into surgical practice.
Case selection and surgical considerations
Dr. Sales outlined the types of cases best suited for Endothelium-in DMEK, including post-vitrectomy eyes, anterior chamber intraocular lenses (ACIOLs), and eyes with nearly opaque corneas. He also highlighted situations where Endothelium-out DMEK remains the preferred choice, such as cases involving non-vitrectomized eyes with normal anterior chamber depth.
The discussion also touched on tissue handling, with Dr. Sales recommending a collaborative approach with eye banks to ensure proper graft preparation.
Looking ahead: Efficiency and outcomes
One of the key takeaways from the webinar was the efficacy of DMEK compared to Descemet Stripping Automated Endothelial Keratoplasty (DSAEK). Dr. Sales cited studies suggesting that while DMEK may initially pose a learning curve, it offers long-term benefits such as faster visual recovery, reduced interface fluid complications and better endothelial cell survival.
Stay tuned for more insights
Eversight Academy’s webinar series continues in May with a session featuring Dr. Sophie Deng from the UCLA Jules Stein Eye Institute, discussing the management of limbal stem cell deficiency. Stay connected for more educational opportunities as we explore the latest advancements in corneal care.
Missed the webinar? Keep an eye on your inbox for future sessions and join us as we continue advancing the gift of sight through innovation and collaboration.
Thank you to our expert
Christopher Sales, MD, MPH is a tenured Associate Professor at the University of Iowa Department of Ophthalmology and Visual Science. He specializes in keratoplasty, anterior segment reconstruction, cataract, and refractive surgery, with a focus on complex DMEK. He is the founding director of both the Iowa Eye Device Lab and the CIRCA Fellowship, serves on the department’s executive leadership committee as a Vice Chair, and is helping to spearhead a BioDesign program for the University’s Office of Innovation. He is a serial inventor recognized by the National Academy of Inventors and a med-tech entrepreneur.
Eversight's free webinars are a great way for you to connect, learn and train digitally with leading ophthalmologists and researchers from around the world. We invite you to RSVP for scheduled webinars and browse our recording library.
Have an idea for a future topic? Interested in receiving timely and relevant information from Eversight? We'd love to hear from you!