2006年にオランダ人の天才眼科医Melles博士が開発した角膜後面の置換術（DMEK）とは、角膜内皮とその基底膜(土台)であるデスメ膜（Descemet 膜）をシート状に切り取り、あたかも壁紙を張り替えるように新鮮な内皮細胞シートと置き換えます。術後の視力回復が素晴らしく、白内障手術に極めて近い視力回復が期待できます。

2014年にドイツでこの技術を教わりましたが、日本人で本手術を導入するにあたり、いろいろと苦労もあり、様々な工夫を行い、世界に向けて論文という形で発表してまいりました。

2019年よりドイツ政府の留学生として、1年弱再度留学も行い、多くの手術に関わって、現地でも研究計画を提案し、結果を公表してまいりました。

手術が何分でできるとかそういった次元のものではなく、詳細な術後診察の中で、手術の裏側にある病態や真実を探してまいりました。まだ不明なことも多く、まだまだ自身の手術から振り返らねばならないことは山積みですが、手術して振り返り（手技的な枝葉末節ではなくて）、深層にあるいろんなことを解明し、世の中に発表し続けたいと思います。

最先端の角膜内皮移植術（Descemet membrane endothelial keratoplasty; DMEK）について解説の動画をアップいたしましたので、シェアしたいと思います。

https://youtu.be/6RxQKi6Lsvw

本手術に関するこれまでの研究成果は以下、Pubmedから引用しました。

1: Hayashi T, Takahashi H, Inoda S, Shimizu T, Kobayashi A, Kawashima H,
Yamaguchi T, Yamagami S. Aqueous humour cytokine profiles after Descemet’s
membrane endothelial keratoplasty. Sci Rep. 2021 Aug 23;11(1):17064. doi:
10.1038/s41598-021-96566-3. PMID: 34426617; PMCID: PMC8382754.

2: Hayashi T, Hos D, Schrittenlocher S, Siebelmann S, Matthaei M, Franklin J,
Clahsen T, Bock F, Bachmann B, Cursiefen C. Effect of Iris Color on the Outcome
of Descemet Membrane Endothelial Keratoplasty. Cornea. 2020 Jul;39(7):846-850.
doi: 10.1097/ICO.0000000000002305. PMID: 32195753.

3: Hayashi T, Zhang W, Hos D, Schrittenlocher S, Nhat Hung Le V, Siebelmann S,
Matthaei M, Bock F, Bachmann B, Cursiefen C. Descemet Membrane Endothelial
Keratoplasty in Vascularized Eyes: Outcome and Effect on Corneal
Neovascularization. Cornea. 2021 Jun 1;40(6):685-689. doi:
10.1097/ICO.0000000000002502. PMID: 33252385.

4: Hayashi T, Kobayashi A, Takahashi H, Oyakawa I, Kato N, Yamaguchi T. Optical
characteristics after Descemet membrane endothelial keratoplasty: 1-year
results. PLoS One. 2020 Oct 14;15(10):e0240458. doi:
10.1371/journal.pone.0240458. PMID: 33052928; PMCID: PMC7556451.

5: Loreck N, Geries C, Schrittenlocher S, Siebelmann S, Matthaei M, Bachmann B,
Hayashi T, Cursiefen C. Effect of Anticoagulant Therapy on the Outcome of
Descemet Membrane Endothelial Keratoplasty. Cornea. 2021 Sep 1;40(9):1147-1151.
doi: 10.1097/ICO.0000000000002533. PMID: 33009094.

6: Onouchi H, Hayashi T, Shimizu T, Matsuzawa A, Suzuki Y, Kato N. Anatomical
Changes in the Anterior Chamber Volume After Descemet Membrane Endothelial
Keratoplasty. Cornea. 2021 Jun 1;40(6):690-695. doi:
10.1097/ICO.0000000000002535. PMID: 33009090.

7: Siebelmann S, Kolb K, Scholz P, Matthaei M, Franklin J, Händel A,
Schrittenlocher S, Hayashi T, Guell JL, Bachmann B, Cursiefen C. The Cologne
rebubbling study: a reappraisal of 624 rebubblings after Descemet membrane
endothelial keratoplasty. Br J Ophthalmol. 2021 Aug;105(8):1082-1086. doi:
10.1136/bjophthalmol-2020-316478. Epub 2020 Aug 17. PMID: 32816807.

8: Hayashi T, Schrittenlocher S, Siebelmann S, Le VNH, Matthaei M, Franklin J,
Bachmann B, Cursiefen C. Risk factors for endothelial cell loss after Descemet
membrane endothelial keratoplasty (DMEK). Sci Rep. 2020 Jul 6;10(1):11086. doi:
10.1038/s41598-020-68023-0. PMID: 32632151; PMCID: PMC7338484.

9: Inoda S, Hayashi T, Takahashi H, Oyakawa I, Yokogawa H, Kobayashi A, Kato N,
Kawashima H. Factors associated with endothelial cell density loss post Descemet
membrane endothelial keratoplasty for bullous keratopathy in Asia. PLoS One.
2020 Jun 11;15(6):e0234202. doi: 10.1371/journal.pone.0234202. PMID: 32525919;
PMCID: PMC7289356.

10: Schrittenlocher S, Schlereth SL, Siebelmann S, Hayashi T, Matthaei M,
Bachmann B, Cursiefen C. Long-term outcome of descemet membrane endothelial
keratoplasty (DMEK) following failed penetrating keratoplasty (PK). Acta
Ophthalmol. 2020 Nov;98(7):e901-e906. doi: 10.1111/aos.14417. Epub 2020 Mar 20.
PMID: 32198835.

11: Yousefi S, Takahashi H, Hayashi T, Tampo H, Inoda S, Arai Y, Tabuchi H,
Asbell P. Predicting the likelihood of need for future keratoplasty intervention
using artificial intelligence. Ocul Surf. 2020 Apr;18(2):320-325. doi:
10.1016/j.jtos.2020.02.008. Epub 2020 Feb 28. PMID: 32120005.

12: Kobashigawa Y, Shimizu T, Hayashi T, Kobashigawa H, Yuda K, Mizuki N, Yamada
N, Kato N. Iris Posterior Synechiae After Descemet Membrane Endothelial
Keratoplasty in Asian Eyes: Prevention and Management of Posterior Synechiae.
Eye Contact Lens. 2020 Mar;46(2):116-120. doi: 10.1097/ICL.0000000000000616.
PMID: 31429828.

13: Hayashi T, Tabuchi H, Masumoto H, Morita S, Oyakawa I, Inoda S, Kato N,
Takahashi H. A Deep Learning Approach in Rebubbling After Descemet’s Membrane
Endothelial Keratoplasty. Eye Contact Lens. 2020 Mar;46(2):121-126. doi:
10.1097/ICL.0000000000000634. PMID: 31425350.

14: Tase S, Shimizu T, Hayashi T, Tabuchi H, Niimi K, Mizuki N, Kato N.
Descemet’s membrane endothelial keratoplasty for pseudoexfoliation syndrome: a
case series. BMC Ophthalmol. 2019 May 28;19(1):119. doi:
10.1186/s12886-019-1130-1. PMID: 31138243; PMCID: PMC6537358.

15: Yuda K, Kato N, Takahashi H, Shimizu T, Oyakawa I, Matsuzawa A, Yuda K,
Hayashi T. Effect of Graft Shift Direction on Graft Detachment and Endothelial
Cell Survival After Descemet Membrane Endothelial Keratoplasty. Cornea. 2019
Aug;38(8):970-975. doi: 10.1097/ICO.0000000000002015. PMID: 31135493.

16: Inoda S, Hayashi T, Takahashi H, Oyakawa I, Yokogawa H, Kobayashi A, Kato N,
Kawashima H. Risk Factors for Cystoid Macular Edema After Descemet Membrane
Endothelial Keratoplasty. Cornea. 2019 Jul;38(7):820-824. doi:
10.1097/ICO.0000000000001950. PMID: 30973407; PMCID: PMC6571176.

17: Oyakawa I, Hayashi T, Kobashigawa Y, Matsuzawa A, Takahashi H, Kato N.
Evaluation of Anterior and Posterior Corneal Irregularity After Descemet
Membrane Endothelial Keratoplasty. Cornea. 2018 Nov;37(11):1360-1365. doi:
10.1097/ICO.0000000000001722. PMID: 30124590.

18: Shimizu T, Hayashi T, Yuda K, Takahashi H, Oyakawa I, Yamazaki K, Mizuki N,
Kato N. Short Axial Length and Iris Damage Are Associated With Iris Posterior
Synechiae After Descemet Membrane Endothelial Keratoplasty in Asian Eyes.
Cornea. 2018 Nov;37(11):1355-1359. doi: 10.1097/ICO.0000000000001698. PMID:
30004959.

19: Hayashi T, Oyakawa I, Matsuzawa A, Yuda K, Shimizu T, Tsuchiya A, Mizuki N,
Kato N. Descemet membrane endothelial keratoplasty using ophthalmic viscoelastic
devices for eyes with laser iridotomy-induced corneal endothelial
decompensation: Analysis of 11 eyes. Medicine (Baltimore). 2018
Jun;97(26):e11245. doi: 10.1097/MD.0000000000011245. PMID: 29952990; PMCID:
PMC6039634.

20: Yamada N, Hayashi T, Yuda K, Shimizu T, Oyakawa I, Takahashi H, Kato N.
Outcomes of Descemet Membrane Endothelial Keratoplasty for Vitrectomized Eyes
with Sutured Posterior Chamber Intraocular Lens. J Ophthalmol. 2018 Apr
11;2018:3127126. doi: 10.1155/2018/3127126. PMID: 29850201; PMCID: PMC5925161.

21: Hayashi T, Kobayashi A. Double-Bubble Technique in Descemet Membrane
Endothelial Keratoplasty for Vitrectomized Eyes: A Case Series. Cornea. 2018
Sep;37(9):1185-1188. doi: 10.1097/ICO.0000000000001606. PMID: 29634673.

22: Matsuzawa A, Hayashi T, Oyakawa I, Yuda K, Shimizu T, Mizuki N, Yamada N,
Kato N. Use of four asymmetric marks to orient the donor graft during Descemet’s
membrane endothelial keratoplasty. BMJ Open Ophthalmol. 2017 Aug 4;1(1):e000080.
doi: 10.1136/bmjophth-2017-000080. PMID: 29354713; PMCID: PMC5721642.

23: Hayashi T, Yamaguchi T, Yuda K, Kato N, Satake Y, Shimazaki J. Topographic
characteristics after Descemet’s membrane endothelial keratoplasty and
Descemet’s stripping automated endothelial keratoplasty. PLoS One. 2017 Nov
30;12(11):e0188832. doi: 10.1371/journal.pone.0188832. PMID: 29190797; PMCID:
PMC5708795.

24: Hayashi T, Yuda K, Oyakawa I, Kato N. Use of Brilliant Blue G in Descemet’s
Membrane Endothelial Keratoplasty. Biomed Res Int. 2017;2017:9720389. doi:
10.1155/2017/9720389. Epub 2017 Jun 6. PMID: 28676862; PMCID: PMC5476887.

25: Hayashi T, Oyakawa I, Kato N. Techniques for Learning Descemet Membrane
Endothelial Keratoplasty for Eyes of Asian Patients With Shallow Anterior
Chamber. Cornea. 2017 Mar;36(3):390-393. doi: 10.1097/ICO.0000000000001093.
PMID: 28002113; PMCID: PMC5291281.