Descemet’s Membrane Endothelial Keratoplasty (DMEK) is a modern corneal transplant. This procedure replaces the innermost, diseased layer of the cornea (Descemet’s membrane and its endothelial cells) with healthy donor tissue. This delicate approach aims to restore vision by addressing conditions that cause corneal swelling, such as Fuchs’ endothelial dystrophy. Success of this precise surgery relies significantly on careful post-operative adherence to specific instructions.
Understanding the Positioning Requirement
Following DMEK surgery, patients are typically advised to maintain a specific flat positioning for a certain period. This involves lying on one’s back, looking straight up, for 24 to 72 hours. The duration can vary from 24 hours to seven days, depending on the individual case, surgical outcome, and surgeon’s preference. While the goal is to remain in this position as much as possible, short breaks are usually permitted for essential activities.
The Role of the Gas Bubble
Flat positioning after DMEK surgery is related to the gas or air bubble inside the eye. Surgeons inject this bubble to hold the transplanted corneal tissue against the back of the cornea. This bubble acts as a temporary internal splint, ensuring the graft adheres properly as it heals. Because gas naturally floats in liquid, the supine (face-up) position allows the bubble to press against the graft, providing continuous support. Over time, the gas bubble slowly dissipates and is absorbed by the eye, typically within one to two weeks, as the graft attaches.
Practical Guidance for Post-Op Positioning
Maintaining the required flat position after DMEK surgery can be made more manageable with practical strategies. Patients can use a recliner or arrange pillows to support their head and neck, remaining comfortably face-up. Setting alarms for short breaks, typically 10 to 20 minutes every hour, allows for necessary activities like eating, using the restroom, or taking medications. When sleeping, patients should try to remain on their back, using an eye shield at night for at least one week to protect the healing eye from accidental rubbing.
While maintaining the position, certain activities should be avoided initially. Patients should refrain from bending over, lifting heavy objects (typically more than 7 kg), or engaging in strenuous exercise for at least two weeks. Avoiding activities that might increase pressure in the eye or cause injury, such as rubbing the eye or getting soap directly into it, is also important. These precautions help prevent dislodgement of the fragile graft and promote successful healing.
Recognizing and Addressing Potential Issues
Patients should be aware of signs indicating a problem after DMEK surgery, requiring immediate medical attention. While some blurriness, mild irritation, and redness are expected, significant changes warrant concern. Symptoms such as increasing pain, worsening redness, or a sudden, marked decrease in vision after an initial improvement could signal an issue with the graft or the gas bubble. A dislodged graft, where transplanted tissue shifts, can lead to persistent corneal swelling and blurred vision.
If any of these concerning symptoms arise, especially severe eye pain, nausea, vomiting, or a sudden loss of vision, contacting the surgeon immediately is important. Early recognition and intervention can often address complications such as graft detachment, sometimes requiring a procedure to reinject an air bubble to help reattach the tissue. Following all post-operative instructions and attending scheduled follow-up appointments allows healthcare providers to monitor healing and address any potential issues promptly.