Back to Journals » Clinical Ophthalmology » Volume 13

Perceived difficulties and barriers to uptake of Descemet’s membrane endothelial keratoplasty among surgeons

Authors Zafar S, Parker JS, de Kort C, Melles G, Sikder S

Received 19 April 2019

Accepted for publication 13 May 2019

Published 21 June 2019 Volume 2019:13 Pages 1055—1061


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Dr Scott Fraser

Sidra Zafar,1 Jack S Parker,2,3 Christa de Kort,3,4 Gerrit Melles,3,4 Shameema Sikder1

1Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins Hospital, Baltimore, MD, USA; 2Parker Cornea, Birmingham, AL, USA; 3Netherlands Institute for Innovative Ocular Surgery-United States of America, San Diego, CA, USA; 4Melles Cornea Clinic, Rotterdam, Netherlands

Purpose: To determine barriers related to implementation of Descemet’s membrane endothelial keratoplasty (DMEK) among corneal surgeons.
Methods: This was a multicenter survey study of all corneal surgeons who participated in a DMEK wet lab organized by the Netherlands Institute for Innovative Ocular Surgery. Data related to barriers limiting uptake of DMEK surgery, self-perceived levels of competence, and difficulty with different steps of DMEK surgery were analyzed.
Results: The survey response rate was 31% (22 of 72). The most common barrier to uptake of DMEK surgery identified was anxiety related to incorrect insertion of the tissue and the need to regraft (64%, 14 of 22), followed by anxiety related to tissue preparation (50%, eleven of 22). Surgeons also felt anxious regarding the possibility of rebubbling with initial DMEK (41%, nine of 22). Steps related to DMEK graft (76%) preparation, tissue insertion (41%), and graft unfolding (72%) were identified as the most difficult steps to learn by the respondents.
Conclusion: The DMEK learning curve, especially for the novice surgeon, may be shortened by seeking educational resources, including wet labs and surgical videos. Eye banks may facilitate adoption of DMEK by making validated DMEK tissue more accessible to surgeons globally.

Keywords: DMEK, uptake, barriers, difficulties

Creative Commons License This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at and incorporate the Creative Commons Attribution - Non Commercial (unported, v3.0) License. By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms.

Download Article [PDF]  View Full Text [HTML][Machine readable]