DSEK, or descemet’s stripping endothelial keratoplasty, is a partial thickness corneal transplant that requires a thin piece of donor tissue to be placed on the back surface of the cornea. Prior to the development of DSEK, the only options for patients with reduced vision or blindness due to corneal disease was complete cornea transplant. During a DSEK procedure, only the innermost layer of the cornea, the endothelium, is transplanted, reducing incision size and recovery times.
The first part of the DSEK procedure involves the removal of the diseased endothelium and its underlying membrane. This is then replaced with the healthy inner layer of the cornea from a donor.
Prior to the procedure, a local anesthetic is injected to anesthetize and immobilize the eye so that no discomfort is felt. Two small incisions are then made in the eye. The incisions are small enough that they often do not require sutures, but allow the passage of microsurgical instruments which are gently used to strip off the diseased endothelium from the central portion of the patient’s cornea.
The donor endothelium is prepared with the aid of a sophisticated instrument called a microkeratome. This instrument precisely removes the inner layer of the donor cornea to produce the “donor button”. The donor button is gently folded and placed within the fluid-filled anterior chamber of the eye beneath the patient’s cornea.
After centering the donor button in the precise location, a delicate hook is used to secure the transplant, while sterile air is gently injected into the anterior chamber of the eye. This causes the donor button to unfold in the exact location where the diseased tissue has been removed.
When the anterior chamber has been completely filled, the air bubble serves to hold the graft in place until the natural functioning of the new endothelium resumes and the new tissue adheres to the patient’s cornea. This usually takes only 8-10 minutes.
After surgery, the patient lies flat for approximately 1 hour. The surgeon then examines the patient with the microscope. If the new cornea is in place, a small amount of the air is removed and the patient is ready to go home. Patients are given antibiotic and anti- inflammatory eye drops and are seen
Unlike the full thickness Penetrating Keratoplasty (PK), DSEK uses a much smaller incision resulting in a more stable wound that is less likely to open with trauma. DSEK can also reduce the risk of complications such as hemorrhaging that could threaten your vision.