Vision Correction

Cornea Transplant Surgery & DSAEK

Descemet's stripping automated endothelial keratoplasty (aka DSAEK or DSEK):

As we age, various disease states cause the cornea (the front clear window of the eye) to become cloudy.  The top three conditions that cause the cornea to become cloudy are: 1) Fuch’s Dystrophy (a genetic condition which causes gradual clouding of the cornea with age), 2) Pseudophakic bullous keratopathy (a cloudy cornea that arises after cataract surgery), and 3) graft failure after previous cornea transplantation.  These conditions cause the inner layer of the cornea known as the corneal endothelium to lose it’s normal function.  The cornea endothelium’s primary function is to maintain the clarity, thickness and water content of the cornea.

Descemet's stripping endothelial keratoplasty is rapidly becoming the preferred treatment for corneal endothelial dysfunction.   Descemet’s Stripping Automated Endothelial Keratoplasty (DSAEK) is a posterior corneal transplantation technique that replaces dysfonctional recipient endothelium with healthy donor tissue while sparing the entire recipient stroma.  DSAEK is currently recognized as the "state-of-the-art" in the endothelial keratoplasty field.  DSAEK produces excellent visual outcomes with minimal change in corneal surface topography or refraction. It can successfully treat corneal dysfunction associated with Fuchs' endothelial dystrophy, bullous keratopathy, iridocorneal endothelial syndrome or a failed cornea transplant.  Donor dissection has become automated, and new techniques have been devised to facilitate graft insertion and unfolding.  We now routinely perform DSEK with topical anesthesia.  Graft detachment is the most frequent early postoperative complication, but new methods can help promote donor adherence.  The incidence of graft-rejection episodes is lower after DSEK compared with standard penetrating keratoplasty, possibly because wound healing is a lesser concern.

We have been doing DSAEK and DSEK since early 2008.  The results have proven themselves to be much better than the results of full-thickness cornea transplantation.  There is recovery of functional vision within weeks (rather than 6-12 months with full-thickness cornea transplantation), the procedure is safer and less invasive than regular cornea transplantation.

Dr. Melles first described the surgical technique for posterior lamellar keratoplasty, in 1998.  Then in 2001, Dr. Terry adopted this technique in the United States and renamed the procedure DLEK (Deep Lamellar Endothelial Keratoplasty).  In 2004, Dr. Melles described a technique in which he simply stripped Descemet’s membrane from the recipient and thus converted the DLEK name to DSEK name.  To achieve better and more consistent posterior donor quality, the donor lamella is now obtained thanks to the use of the MORIA automated lamellar microkeratome unit. Thus, the procedure is now currently named "DSAEK”.

Advantages of DSAEK

• Stronger wound, resistant to trauma.
• Astigmatically neutral.
• Corneal nerves preserved.
• Faster recovery of vision compared to full-thickness cornea transplantion.
• No suture related complications.