The cornea is the clear, living tissue on the very front part of the eye. Light passes through the clear cornea on its path toward the retina in the back part of the eye. A healthy, clear cornea is necessary for perfectly clear vision. Sometimes, the cornea is referred to as the”window” to the eye. Occasionally, either through disease or injury, the corneal tissue is damaged to a point where light can no longer effectively pass through it, resulting in reduced vision.

Typically, patients with corneal diseases are required to have a full thickness corneal transplant, or penetrating keratoplasty (PK), in order to improve their vision. However, some diseases of the cornea only affect the inner lining of the cornea. Therefore, a new version of corneal transplant, known as a Descemet’s Stripping Endothelial Keratoplasty (DSEK), has been introduced as a new surgical method that uses only a very thin portion of the cornea for transplant.

DSEK 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 the eye bank. Unlike the PK, the DSEK procedure utilizes a much smaller surgical incision and requires no corneal sutures. This usually results in more rapid visual rehabilitation for the patient and also reduces the risk of sight threatening complications that may occur with the PK.

The DSEK procedure involves three main steps: (1) preparation of the donor cornea, (2) removal of the diseased endothelium, and (3) insertion and adherence of the new donor endothelium. The preparation of donor tissue requires the use of an artificial anterior chamber to create the desired donor posterior corneal tissue.

The DSEK procedure can overcome many of these problems associated with a standard corneal transplant. With a DSEK procedure only the abnormal inner lining of the cornea is removed. A thin, circular disc is then removed from the inner lining of a donor cornea. This is folded and place inside of the eye where an air bubble pushes it in place until it heals in an appropriate position. No sutures are required and the structure of the cornea remains intact, leading to a faster visual recovery and less astigmatism.

The procedure takes approximately 45 minutes. For the first 24 hours you will be asked to lie on your back with your face pointed directly to the ceiling for as much time as you can tolerate. This will help the graft stay in position as the air bubble holds it up into place on your cornea.