Original Publication
Open Access

Development of a Wet Laboratory Curriculum for Descemet's Membrane Endothelial Keratoplasty

Published: May 15, 2015 | 10.15766/mep_2374-8265.10101

Included in this publication:

  • Instructor's Guide.docx
  • Required Materials and Instructor Checklist.docx
  • Student Objectives and Recommended Resources.docx
  • Pre Post Quiz with Answers.docx
  • Pre Post Quiz without Answers.docx
  • A1-Introduction to DMEK.pptx
  • A2-Method of Donor Tissue Preparation.pptx
  • A3-DMEK Procedure.pptx
  • A4-DMEK Complications and Management.pptx
  • 01-DMEK Tissue Preparation Scoring and Staining.mp4
  • 02-DMEK Tissue Preparation Checking Edges and Staining.mp4
  • 03-DMEK Tissue Preparation Stripping EDM from Posterior Stroma.mp4
  • 04-Recap of Donor Tissue Preparation.mp4
  • 05-DMEK Surgical Procedure Recipient Preparation.mp4
  • 06-DMEK Surgical Procedure Graft Preparation and Insertion.mp4
  • 07-DMEK Surgical Procedure Graft Positioning and Apposition.mp4
  • Student Instructor and Module Evaluation.docx
  • Curriculum Student Objectives and Recommended Resources.docx
  • Wet Lab Foundation and Required Materials.docx
  • Lab Manual.docx
  • Student Instructor and Wet Laboratory Evaluation.docx
  • Instructor Evaluation of Student.docx

To view all publication components, extract (i.e., unzip) them from the downloaded .zip file.


Editor's Note: This publication predates our implementation of the Educational Summary Report in 2016 and thus displays a different format than newer publications.

Abstract

Descemet membrane endothelial keratoplasty (DMEK) is one of the most advanced procedures in lamellar corneal transplantation. One of the barriers to adopting this procedure is the shortage of teaching programs, both in the United States and worldwide. We developed a DMEK teaching curriculum for implementation at established cornea training programs to effectively increase the availability of institutions teaching fellows and faculty to practice this state-of-the-art procedure. The course consists of a module with an Instructor’s Guide and content for both a didactic segment and a supervised wet laboratory experience. The course begins with a didactic lecture series that introduces ophthalmologists to DMEK and prepares them for the subsequent wet lab experience. In the lab, participants have an opportunity to practice DMEK tissue preparation, recipient preparation, and graft insertion orientation and adhesion on cadaver globes specially prepared for corneal transplantation. This learning module was developed at the Kellogg Eye Center at the University of Michigan in an effort to expose cornea fellows and senior residents interested in pursuing corneal fellowship to DMEK as a frontline treatment for endothelial dystrophies. Course participants felt the one-on-one experience and use of donor globes and corneal tissue were the most beneficial aspects of the wet lab. They believed the use of human tissue helped simulate surgery on a real patient. Additionally, regarding the didactice segment, they thought that the videos demonstrating techniques and hearing from experienced physicians were valuable. Shortcomings included soft globes requiring repeat inflation with balanced salt solution. Though we do not have data showing the proportion of surgeons who began practicing DMEK, we know that one attendant from our most recent wet lab began performing DMEK. Additionally, our attendants rated 5 (Strongly agree) to the statement “I feel better prepared to practice DMEK on a real patient.”


Educational Objectives

At the end of the module, learners will be able to:

  1. Define what constitutes Descemet membrane endothelial keratoplasty (DMEK).
  2. Describe the indications and contraindications for DMEK.
  3. Explain the benefits of DMEK as treatment for endothelial disorders.
  4. Report the risks involved with DMEK.
  5. Cite the studied outcomes of DMEK.
  6. Differentiate between Descemet’s stripping automated endothelial keratoplasty (DSAEK) and DMEK.
  7. Explain the process of preparing donor tissue, including the use of instruments involved.
  8. Explain the process of performing DMEK, including the use of instruments involved.

After successful practice in the wet laboratory, learners will be able to:

  1. Demonstrate fine motor and proprioception skills while operating under the microscope (trainees only).
  2. Demonstrate proficiency in working in a small surgical field as both a surgeon and assistant using the microscope (trainees only).
  3. List the differences in DMEK instruments and the proper usage for each.
  4. Demonstrate performance of five adequate incisions along with correct placement of paracentesis on cadaver eye models.
  5. Identify and demonstrate performance of the steps of DMEK tissue preparation.
  6. Identify and demonstrate performance of the steps of DMEK on animal/cadaver eye models.
  7. Differentiate donor tissue preparation and surgical procedure for DMEK and Descemet’s stripping endothelial keratoplasty (DSEK)/DSAEK.

Author Information

  • Shahzad Mian, MD: University of Michigan Medical School
  • Hassan Tausif: University of Michigan Medical School

Disclosures
None to report.

Funding/Support
None to report.



Citation

Mian S, Tausif H. Development of a wet laboratory curriculum for Descemet's membrane endothelial keratoplasty. MedEdPORTAL. 2015;11:10101. https://doi.org/10.15766/mep_2374-8265.10101