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.
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What is Descemet's Stripping Endothelial Keratoplasty (DSEK)?
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.
Individuals with corneas defects and damage limited to the inner cornea layer (endothelium)
Patients with inherited Fuch’s Endothelial Dystrophy and Iridocorneal Endothelial Syndrome
Those who have acquired corneal stromal edema (Aphakic bullous keratopathy)
Have no other health issues affecting their eyes
The objective of DSEK surgery
DSEK is intended to transplant a healthy endothelial cell layer that will pump the fluid out of the cornea. It’s expected to restore corneal clarity and improve vision. This procedure corrects corneal endothelium failure, but is not able to correct corneal scarring, thinning or surface irregularity.
During your visit
Not all patients with corneal pathology are candidates for DSEK. The indication depends on decreased vision related to corneal swelling from poorly functioning endothelium. During your visit your surgeon would conduct a thorough eye examination, after your doctor reviews your results he will let you know if DSEK is the right procedure for you. If you are deemed a good candidate, Atlantic Eye will provide you with all of the information needed to help you make an informed decision.
Give yourself plenty of time to think about the risk/benefit discussion, to review any informational literature provided by your doctor, and to have any additional questions answered by your doctor before deciding to go through with surgery and before signing the informed consent form.
Before surgery the patient will receive mild relaxing medications and anesthetic injections around the eye. After the eye is cleaned and prepared with a sterile drape, the patient is then brought to the operating room located in our ambulatory surgery center.
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.
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.
After the surgery, the patient lies in a supine position, flat, facing the ceiling, for the first hour after surgery and then as much as possible to allow the retained air bubble to further stabilize the graft position, but this is not critical.
The patient is discharged following this outpatient procedure when fully recovered from the anesthesia. You will be 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 your activities. The vision is usually better within one week. 80% of the healing has taken place by one month but the vision can continue to slowly improve over the next four to six month.
Postoperative care should include broad-spectrum antibiotics to prevent infection and steroids (initially dexamethasone, then fluorometholone) to prevent rejection. Patient should lie in the supine position for one more day after DSEK (to utilize the residual air bubble in the anterior chamber) and to not rub their eye for 2 weeks after DSEK surgery.
With either procedure there is a risk of rejection, where the body’s immune system starts to fight against the cornea. The symptoms of rejection are redness, blurry vision, and light sensitivity. This can happen at any time months or years after the transplant. A complication that can occur from the DSEK procedure that is not associated with a standard transplant is a graft dislocation, where the circular disc slips from its intended position. In this circumstance the donor disc needs to be repositioned in the operating room.
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