dsaek corneal transplant

Dsaek (Descemet Stripping Endothelial Keratoplasty) Sutureless Corneal Endothelial Transplant

For the treatment of corneal swelling, DSAEK is a way of performing a safer corneal transplant than traditional PENETRATING KERATOPLASTY (PKP). 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.

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.

What Is Corneal Swelling?

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.

Donor Corneas – Where Do They Come From?

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.

How Is Dsaek Done?

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.


Before Your Surgery:

Your surgeon will meet with you in our office and examine you before deciding on surgery. 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 and the staff at Milan Eye Center will explain post-operative care and will address any other questions you might have about your outpatient surgery, 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.

Post-Operative Care:

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 no pain after surgery although some light sensitivity and scratchiness is common. Visual recovery varies depending on the severity of your corneal cloudiness prior to surgery. Most patients notice 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.

Post-operative visits are scheduled at one day, one week, and one month after the procedure, then monthly depending on the patient’s progress.

  • You will usually be able to resume most activities 2 days after surgery.
  • Eye makeup is allowed at 1 week and swimming at 4 weeks after surgery.
  • Exercise such as treadmill, or walking are permitted at 1 week.
  • Jogging or weight lifting should be avoided for 3 to 4 weeks.

You will likely have a change in your eye glass prescription at some point after the surgery.

Advantages Of Dsaek:

  • Visual recovery is significantly faster.
  • The eye is less susceptible to injury after surgery.
  • There is usually less astigmatism and less change in your eyeglass prescription.
  • Suture related problems are reduced.
  • There are fewer restrictions on physical activity after the surgery.

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“Seeing Dr. Sajja was very easy and efficient. He was very thorough and professional. He was also very honest in what he felt needed to be done. He also had a very good bedside manner and was caring, nothing was painful at all. The surgery was a quick procedure and I was in excellent care. I was amazed that Dr. Sajja himself called me two days after surgery to check-up on me!”

“Dr. Milan Patel is an excellent, caring physician. From the initial exam through cataract surgery he was very patient with explaining the surgery and recovery process. I had both eyes replaced with new lenses and felt extremely comfortable through both procedures. I highly, highly recommend him!”

“I was scared of having my cataracts removed, but the doctor and all of the staff made me most comfortable. There was no pain & the recovery was short. I would recommend Dr. Desai to anyone who needs surgery. And the people who work there are just wonderful”
Deb Hallinyer