CORNEAL TRANSPLANTS/DSEK

DSEK also known as DSAEK
DSEK (Descemet’s Stripping Automated Endothelial Keratoplasty)

DSAEK (Descemet’s Stripping Automated Endothelial Keratoplasty) is a form of corneal transplant surgery. It is indicated for corneal swelling caused by:

Fuchs Dystrophy
Decompensated endothelium

DSAEK (Descemet’s Stripping Automated Endothelial Keratoplasty) is a corneal transplant technique where the unhealthy, diseased, posterior portion of a patient’s cornea is removed and replaced with healthy donor tissue obtained from an eye bank. Unlike traditional corneal transplant surgery, the DSAEK procedure utilizes a much smaller surgical incision and requires no corneal sutures. DSAEK usually results in more rapid visual recovery and also reduces the risk of sight threatening complications that may occur with a corneal transplant, such as intraoperative expulsive hemorrhage or post operative traumatic would rupture.

Understanding The Cornea and Corneal Transplants

Although the cornea is clear and seems to lack substance, it is actually a highly organized group of cells and proteins. Unlike most tissues in the body, the cornea contains, under normal circumstances, no blood vessels to nourish or protect it against infections. Instead, the cornea receives its nourishment from the tears and aqueous humor that fills the chamber behind it. The cornea must remain transparent to refract light properly, and the presence of even the tiniest blood vessels can interfere with this process. To see well, all layers of the cornea must be free of any cloudy or opaque areas.

The corneal tissue is arranged in five basic layers, each having an important function. These five layers are: Epithelium, Bowman's Layer, Stroma, Descemet's Membrane, and Endothelium. For the purpose of DSAEK the Endothelium is the back part of the cornea closest to the eye that is the section in question.

Why cornea transplants are required?

Cornea transplants are required for a number of corneal diseases and variety of other reasons. Before and after transplant, you will need ongoing information and support. You do not need to go through the cornea transplant surgery and recovery alone. Our cornea surgery experts located in Erie PA, can help you understand what you will be facing with DSEK or traditional cornea transplant surgery.

On the day of surgery, the patient will arrive at the surgery center approximately one hour prior to surgery for preparation. The patient must not eat anything after midnight the day before surgery and will begin pre-operative medications three days prior to surgery as instructed. Prior to the patient’s surgery the surgeon will prepare for surgery by determining the type of tissue to be used and selecting the technique needed to ensure the best surgical outcomes possible. In DSAEK the innermost layer (closest to the inside of the eye, known as the Endothelium) is removed. An automated dissector harvests a thin piece of donor tissue that is then placed into the operative eye. It is secured to the cornea by an air bubble. Two or three stitches may be needed to close the initial incision. In the operating room you will be receiving anesthesia for relaxation and numbing medicine. Surgery typically lasts 1 hour. At the end of the procedure you stay lying on your back for another 40 minutes. At that point the surgeon examines your eye to ensure proper placement of the tissue, as well as check the eye pressure. You are then sent home with an eye patch. You will be directed to use eye drops frequently after the surgery. These are typically reduced at an appropriate time period following surgery. Visual recovery can change with each patient but usually takes three to six weeks for recovery. Please be advised that you might need a different prescription in your glasses or contact lenses to enhance your vision.

Benefits of DSAEK

Improved vision
Less risk than a traditional corneal transplant
Less recovery time compared to corneal transplantation
Less astigmatism compared to corneal transplantation
Reduced discomfort compared to before surgery
Potential improvement in lifestyle functioning

Articles about DSAEK: Bubble Vision

By David Bruce

Jane Mallory's left eye was betraying her. Her vision was so cloudy that she needed a magnifying glass to read. Every time Mallory blinked, it felt like someone had tossed gravel in her eye."It's irritating more than anything," said Mallory, 73, while awaiting a cornea transplant at the Saint Vincent Surgery Center."I use drops and ointments, but it seems to be getting worse." Mallory's ophthalmologist, Rob Haverly, M.D., diagnosed her with Fuch's dystrophy, an inherited disease that damages the cornea, the clear surface on the front of the eye. The only way to restore Mallory's vision was with a cornea transplant. Instead of a traditional transplant, however, Haverly offered her a new version called Descemet's Stripping Endothelial Keratoplasty, or DSEK.

"Full cornea transplants work, but the recovery time can take six months to a year," Haverly said."With DSEK, a patient can regain their vision within six to eight weeks." Patients recover quicker because Haverly doesn't replace the entire cornea with a donor cornea. He instead removes only the diseased layer of cells at the back of the cornea, an area called the endothelium, and replaces it with a donor's endothelium."You also don't have the same risk of bleeding or infection because you haven't removed the entire front of the eye and exposed it to the elements, " Haverly said. A shorter recovery time and less chance of infection appealed to Mallory, who underwent DSEK on Wednesday at the Saint Vincent Surgery Center.

Haverly began the procedure before Mallory was wheeled into the operating room. He used a specialized tool to slice the endothelium from a donor cornea, then punched the center out of it for transplant. "You could use one donor cornea for two transplants, if the patients required different parts of it," Haverly said."Usually we use each one once, though."

Mallory was awake but lightly sedated when she was wheeled into the operating room. Her eye was then numbed with a local anesthetic. Haverly cut a flap in the side of Mallory's cornea and cut out her diseased endothelium. He slid the donor tissue, which was folded like a soft taco, into the gap and opened it up. The entire procedure took less than 20 minutes and required one suture, compared to about 45 minutes and between 16 and 20 sutures for a full cornea transplant. Once the donor tissue was placed into position, Haverly added an air bubble beneath it."We do that to hold the donor tissue in place until it attaches to the patient's tissue," Haverly said."If we didn't, the donor tissue would just float around in the eye."

Mallory had to lie flat on her back for an hour after surgery to keep the air bubble in place, and was asked to lie that way as much as she could for the next 24 hours. The donor tissue eventually attaches itself and the air bubble dissolves on its own, Haverly said.

DSEK isn't an option for every patient who needs a cornea transplant. Only people who have damage or disease to their endothelial cells can have the procedure, which would account for two-thirds of the 35,000 cornea transplants done each year in the United States. Mallory will know by the first day of spring if her vision will be strong enough to read without a magnifying glass.

Betty Wilson, who received a DSEK transplant from Haverly in October, said her vision is good and her right eye no longer feels like it has an eyelash in it all the time. "He had to readjust the air bubble a couple of times, but the result was good," said Wilson, 79, who needed the procedure after her a previous cornea transplant failed."I was fully healed in a little more than a month, and my vision is almost good enough now that I don't even need glasses."

"The laser corrective surgery is probably one of the best decisions I have made in my lifetime. I wore glasses for 34 years, and it is truly a blessing not to wear them anymore. The procedure is short and virtually painless. As a person who has had this done I would recommend laser surgery to anyone who is a candidate and who can afford it. Dr. Haverly's staff was very, very professional and courteous. It is truly a miracle. Thank you."
Mark Jordanm, Coordinator, age 39

"I had laser refractive surgery because I did not want to bother with contacts. I like being able to see clearly when I wake up in the morning and not have to fumble around for glasses. It's wonderful being able to see objects in the distance without aid. I highly recommend Laser Eye Surgery of Erie. The surgery was quick and painless. Dr. Haverly, Dr. Gellis, and the office staff have been wonderful through this experience."
Joanne Troutman, Clerical Worker, age 40

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