Descemet’s Stripping with Endothelial Keratoplasty (DSEK) is a newer cornea transplant technique that replaces the damaged innermost cell layer (endothelium) tissues instead of replacing the entire thickness of the cornea. It is used when the inner cell layer of the cornea cannot function and the cornea then becomes swollen. Compared to Penetrating Keratoplasty (PKP), the cornea heals much faster, is stronger and the patient’s visual recovery is faster. Because this technique does not adversely affect the corneal surface and thus significantly improves the visual results, it has become a preferred method for treatment of Fuchs’ Dystrophy and pseudophakic bullous keratopathy.
During surgery, a thin circular disc is collected from the inner lining of a donor cornea. This disc of tissue is placed inside of the eye with the swollen cornea (so it can cover the inner wall of the cornea in the patient’s eye) and an injected air bubble pushes it into place until it self-seals in the appropriate position. No sutures are required for the graft, and the main structure of the cornea remains intact, leading to a faster visual recovery and less astigmatism.
The DSEK procedure is done under local anesthesia and takes approximately 30 minutes. For the first 24 hours after surgery patients are asked to lie on their back with their face pointed directly to the ceiling for as much time as they can tolerate. This helps the graft stay in position as the air bubble holds it in place on the inside surface of the cornea. Patients are given several drops to use to prevent infection as well as to help the eye heal comfortably. After the first 48 hours there are minimal restrictions to activities. The vision is usually better within one week. About 80% of the healing has taken place by one month, and the vision can continue to slowly improve over the next four to six months.