Descemets Stripping
Endothelial Keratoplasty (DSEK)
The cornea is comprised of five basic layers of tissue. During a traditional corneal transplant, known as a "penetrating keratoplasty" or "PKP", a circular disc of the full thickness of the cornea--all five layers-- is removed from the center of cornea and replaced with healthy donor tissue. This new tissue is sutured in place. A full thickness corneal transplant has been a safe and effective procedure for the treatment of damaged corneas for many years. However, the recovery can be long, and often the patient will need contact lenses or glasses after the surgery to correct the astigmatism caused by the sutures. The cornea is also more fragile after this procedure and sometimes even minor trauma to the eye can dislocate the graft from its position.
Benefits of DSEK Versus PKP
For the past three years, Dr. Barth has been performing DSEK corneal transplants for patients with persistent corneal swelling and poor vision. This revolutionary procedure has nearly replaced the traditional corneal transplant. With a DSEK procedure, only one of the inner most layers of tissue, the endothelium, and its membrane, the Descemet’s membrane, are stripped off the cornea and replaced with a layer of healthy inner lining of a donor tissue. The advantages of the DSEK method of just transplanting the posterior part of the cornea are numerous:
- A much safer procedure than a full thickness corneal transplant. During a DSEK procedure, only two small incisions needs to be made to allow the microsurgical instruments to strip off the diseased endothelium from the central portion of the patients’ cornea. After the donor corneal tissue layer is prepared, it is gently folded and placed within the fluid-filled anterior chamber of the eye, beneath the patient’s cornea. Injected sterile air creates an air bubble, which causes the donor tissue to unfold and holds it in the exact location where the original tissue was removed. This is a shorter procedure, usually requiring half the time it takes to undergo a traditional penetrating keratoplasty. The small incision, the need for fewer or no sutures, and the shorter procedure time make the DSEK procedure extremely safe and produces amazing visual results.
- Stronger cornea after surgery. Since only the posterior layer has been replaced, minor trauma to the eye is less likely to cause a graft dislocation.
- Much more predictable refraction. Usually fewer sutures are used in a DSEK procedure, and in some cases, none at all. This means smaller changes in astigmatism, nearsightedness or farsightedness after the surgery. Another benefit of using fewer sutures is that the incidence of infection or irritation from them should be greatly reduced. The eye’s refractive status is dependent on the front shape and steepness of the cornea. In the DSEK transplant method, the front surface remains unchanged, leaving better ocular balance between the eyes.
- Quicker visual recover. Compared to the long recovery from a standard full thickness corneal transplant, which can take up to one or two years, visual recovery from a DSEK procedure can be as short as three to six months. This is due to the smaller incision made during the DSEK procedure and the fact that fewer sutures are used.