DSEK (Descemet’s stripping endothelial keratoplasty) and DSAEK (Descemet’s stripping automated endothelial keratoplasty) are partial-thickness corneal transplants that replace primarily the innermost portion of the cornea rather than the full thickness of the cornea as in standard corneal transplants.
DSEK involves transplanting the back layers of a donor cornea into a patient’s eye.
DSAEK is the automated version of this procedure, which utilizes a machine to perform the tissue cutting.
Surgery is performed in an outpatient surgery center conveniently located within our building, eliminating the need for patients to travel to a new location and avoiding hospital admission. Anesthesia is given intravenously and with eye drops (topical anesthesia). The diseased innermost layer of the cornea is removed carefully, and the corresponding thin layer from a healthy donor cornea is put in its place. The transplant is held in place by only an air bubble, requiring patients to lie flat on their backs with their faces directed upwards immediately after surgery to float the bubble into place. The bubble typically dissipates within the first week, and as it does, patients no longer need to lie flat as much. The surgery can be combined with cataract surgery for patients who require both.
There are several advantages to the DSEK or DSAEK operation compared to standard corneal transplant surgery. With an experienced eye surgeon, either surgery itself takes less time than conventional corneal transplantation, involves a smaller surgical incision, requires far fewer stitches, heals faster and more reliably, and the vision returns faster. Since only the thin inner layer of the cornea is replaced, over 90% of the patient’s own cornea remains intact, contributing to greater structural integrity and potentially reducing the incidence of rejection. The smaller incision offers several benefits over traditional methods of corneal transplant.
Because the procedure is less invasive, DSEK or DSAEK leaves the eye much stronger and less prone to injury than full-thickness transplants. Additionally, DSEK or DSAEK has a more rapid rate of visual recovery. Vision is typically restored in one to three months rather than one to two years.
Only patients with endothelial cell problems are candidates for DSEK or DSAEK. Patients with corneal scarring or other conditions will still require the full-thickness corneal transplantation procedure.
An older procedure that is therefore more widely available.
Very cloudy corneas may be able to benefit from DSEK
Transplants are five times larger than comparable DMEK transplants and are therefore more easily seen and transplanted in eyes with very cloudy corneas.
DMEK:
A newer procedure, with relatively few corneal surgeons who have significant experience. (Dr. Yuri McKee of East Valley Ophthalmology is one of those experienced surgeons.)
A relatively clear cornea is needed for DMEK surgery.
Because these transplants are so small, they can be challenging to see inside an eye with a cloudy cornea.
Along with the usual risks related to any eye surgery (which your surgeons will go over with you), with DSEK there is a risk of the thin button of endothelium becoming displaced within the first few days or weeks after surgery and requiring a return trip to the operating room to reposition it, or the operation can be repeated with another button of donor endothelium. If the DSEK or DSAEK fails, either after one or multiple attempts, a traditional corneal transplant operation can still be performed.
