Descemet’s Stripping Automated Endothelial Keratoplasty (DSAEK) is revolutionizing corneal transplantation. Until recently, corneal disease patients had very few treatment choices to regain clear vision. The most likely option was a full thickness corneal transplant – a complicated procedure that surgically replaces the entire cornea from front to back with a donor cornea.
Several diseases can affect the cornea, or clear covering of the eye, such as Fuchs Dystrophy, which causes cloudy vision, and Keratoconus, which creates visual distortion through high and irregular astigmatism. Other surgical options can correct many conditions, but in some cases, a corneal transplant is needed. DSAEK is a non-invasive and advanced technique that uses a small, suture-less incision to remove just the back layer of the cornea. This provides great results with a much faster recovery time than in traditional cornea transplant surgery.
DSAEK involves only replacing some of the posterior or inner layers of the cornea as compared to the standard corneal transplantation (replacement of all layers). While both the standard corneal transplants and anterior lamellar corneal transplants have been done for many years, surgery that replaces the posterior layers of the cornea only is relatively new. Furthermore, DSAEK is only for selected patients with Fuch’s dystrophy or other disorders involving the endothelial or inner layer only.
The DSAEK technique involves peeling off only the inner two layers of your cornea (ie Descemet’s Membrane and Endothelium). This allows replacement of the diseased posterior or inner layers of your cornea while preserving the remaining healthy cornea. In this way, patients retain 80% of their natural cornea and replace only the 20% that is diseased. The back surface of a donor cornea that has been pre-cut to the desired thickness and diameter is then folded and inserted through a small incision into the front fluid chamber of the eye. Once inside, the donor is carefully unfolded and floated up against the back of your cornea with an air bubble. You will be asked to recline or lay flat for about 48 hours in order for the air bubble to float to the top and hold the donor tightly against your cornea. With good compliance with this requirement, the donor cornea typically adheres to back of your cornea without the need for sutures.
Your outpatient surgery is performed at our state-of-the-art Ophthalmic Ambulatory Surgery Center, Deer Creek Surgery Center. The actual surgery takes 30 to 60 minutes, but plan on being at the center for a couple of hours. Surgery is typically done under local anesthetic. You will be given sedation medication and your eye will be completely numbed by a local block. During surgery, you will be unable see very much out of your eye (faint shadows or dim light may be seen). You will be awake but relaxed throughout the procedure.
In the first few days, you may feel a foreign body sensation (a scratchy feeling) in the eye from the incision. Discomfort should go away within one week. Your vision will be blurry after surgery due to swelling and the air bubble used to keep your transplant in place. The swelling may last a few months while the cornea heals but the air bubble should dissolve within the first week. As the air bubble is absorbed and the tissue swelling decreases you should notice a gradual improvement in vision. The doctor will not recommend new glasses until he believes there is sufficient healing. Best vision generally takes three months but may take longer.
During the healing process, you will return to see the doctor frequently. Do not be concerned with visit frequency as transplants require close monitoring. At each visit, you will be given progress updates, medication and treatment instructions. The doctor and staff answer any questions or concerns you may have and schedule your next appointment.
Just as there may be risks and hazards in continuing your present condition without treatment, there are also risks and hazards related to the performance of your surgery. Your physician will review the particular risks relating to your health and the condition of your eye. The complete list of surgical risks is beyond the scope of this website and can be found in the Corneal Transplant consent form you will receive prior to surgery. Some of the potential risks of a DSAEK corneal transplant include, but are not limited to the following:
