DSAEK (Descemet Stripping Endothelial Keratoplasty) is a less invasive corneal transplant surgery. For the treatment of corneal swelling, DSAEK is a way of performing a safer corneal transplant than traditional Penetrating Keratoplasty. Only the damaged endothelial layer is replaced, leaving the remainder of the cornea undisturbed. In a traditional transplant of the cornea, a full thickness incision is made, creating a circular opening in the front of the eye that requires many sutures to secure the transplant. In DSAEK, the new cornea is inserted through a small incision that requires one suture for closure; the graft is then supported by an air bubble until it stabilizes.
The benefits of replacing just one layer are many including shorter post-op recovery, faster visual recovery, less chance of rejection and less invasive repeatability. Surgery is typically insurance covered and takes less than an hour and can often be combined with cataract surgery when necessary. As an outpatient procedure in our surgery center, patients return home within hours and are asked to follow some specific instructions to maximize the chances of success. Visual recovery typically takes a few days, after which, vision improves gradually for several weeks more. Typically, patients can regain excellent levels of vision. Surgeons monitor patients on day one, week one and then monthly for a few months during which patients use a tapering dose of steroid eye drops to prevent rejection and maximize success.
Swelling of the cornea can result from premature aging of the cornea’s inner lining (Fuch’s Endothelial Dystrophy) which is a hereditary condition, or as a result of loss of these inner cells (endothelium) due to trauma, including previous eye surgery. This is where DSAEK can be most helpful in restoring vision. DSAEK does not work in scarred or irregularly shaped corneas.
Losing a loved one is undoubtedly devastating; a donated cornea from a healthy eye is a gift of sight that lives on. ”Donor” refers to the person providing the cornea; ”recipient” is the person receiving the cornea. There is no need to match the tissue, eye color or gender for corneal transplants. We usually do attempt to match the general age, especially when operating on a child or young adult, as these individuals have much longer life expectancy. It is a common misconception that, when donating the corneas, the body will be disfigured. This is not true. Only a portion of the cornea the size of a dime is donated.
Before your surgery, the surgeon will meet with you in our office and examine you before deciding on surgery as the ultimate treatment option. Testing and measurements will be performed at the time of your appointment. Any questions will be answered and the informed consent (giving permission to your surgeon to perform the surgery) will be explained and signed. Our office will review the cost of the procedure (most insurances and Medicare cover much of the cost). Your surgeon will explain the post-operative care and will address any other questions you might have about DSAEK. You will be asked to use antibiotics and other eye drops prior to your surgery, and it is very important not to eat anything after midnight on the night before your procedure.
The surgery is performed under mild sedation. Numbing medication is also used so there is little or no discomfort. Using sophisticated instrumentation adapted from LASIK procedures, the donor cornea is prepared and placed in the recipient’s eye. This new graft is then supported by an air bubble that presses against the recipient’s cornea while the patient is comfortably lying on their back. The bubble takes the place of sutures and is only necessary for a short period of time after completion of the surgery.
Your surgeon will check your healing on the day after surgery. Your vision is not expected to be improved immediately at this visit; in fact, it is usually worse on your first post-op day. There is usually minimal pain after surgery, some light sensitivity and scratchiness are also common. Visual recovery varies depending on the severity of your corneal cloudiness prior to surgery. Most patients notice an improvement in their vision during the first two weeks after surgery with continued improvement during the next four to six weeks. This is faster than the many months and often years of rehabilitation needed after a traditional transplant.
Because the new transplant does not require sutures, there is less induced irregularity or change in the curvature of the recipient cornea (astigmatism). This translates into faster rehabilitation of vision, fewer postoperative physical restrictions and a stronger eye after surgery which is less susceptible to injury from trauma. The surgical incision is smaller and does not greatly alter the eye’s integrity. There is also less concern about sutures breaking and causing infections.
Post-operative visits are scheduled for one day, one week, and one month after the procedure, then monthly depending on the patient’s progress.
You will likely have a change in your eyeglass prescription at some point after the surgery.
If you think you might be a good candidate for DSAEK surgery or another type of corneal transplant, contact us to better understand the treatment options available to you. Make an appointment today at one of our seven convenient locations.
Or call 678-381-2020