North Suburban Eye Specialists is proud to offer a corneal transplant treatment known as DSEK, or Descemet’s Stripping Endothelial Keratoplasty.
Who might be a good candidate for DSEK?
The human cornea is made up of three layers:
- The outer epithelial layer
- The middle stromal layer
- The inner endothelial layer
The inner endothelial layer is made of a single layer of cells and sits on a thin tissue strip called Descemet’s membrane. The role of the endothelial layer is to pump fluid out of the cornea to keep your cornea (and your vision) clear. If the endothelial layer is lost or stops working correctly, the cornea can fill with fluid, become cloudy or swollen, and affect your vision.
How is the endothelial layer lost?
The endothelial layer can be lost or negatively affected due to:
- Inherited diseases (such as Fuchs’ Corneal Dystrophy)
- Previous intraocular surgery
Once a critical amount of the endothelial layer is lost, the cornea swells and becomes cloudy. At this point, medical treatment is no longer helpful, and a corneal operation is necessary. For most patients, the middle stromal layer and outer epithelium layer remain healthy, even as the endothelial layer is affected.
The DSEK Surgery
For your DSEK surgery, donor corneal tissue is obtained from an Eye Bank. Before your surgery, you will be given eye drops and an IV line will help you sleep for a short time. The eye is anesthetized and a small incision is made in your cornea. Your cornea is gently marked on the outside to guide the removal of the affected Descemet’s membrane. One the membrane is removed, the new donor cornea is cut to match the size of the removed membrane. The new cornea is then secured in the correct place using a small air bubble, which seals the membrane in place. Finally, the incision sites are closed and the pressure of your eye is checked to make sure it’s normal following the DSEK procedure.
Pros and Cons of the DSEK Procedure
There are several major advantages to the DSEK procedure over a traditional corneal transplant:
- The operation is faster (60 to 90 minutes).
- The incision is smaller
- The procedure location is more stable and less likely to break open from trauma.
- There is very little postoperative astigmatism.
- Recovery takes only about 3 to 4 months.
- Since only the thin inner layer of the cornea is replaced, over 90% of the patient’s own cornea remains behind. This adds to greater structural integrity and reduced chance of rejection.
DSEK may not be an ideal option for everyone. Patients with prior corneal scarring are not good candidates for DSEK. There are also some risks involved with the DSEK procedure.
- Since DSEK has been done since 2005, there is no long-term follow-up.
- There is a 10% risk of the graft becoming displaced within the first few days or weeks after surgery. This means the graft must be redone with a replacement air bubble in the eye.
- There is minor risk of swelling, infection, and hemorrhaging, and extremely minor risk of poor vision quality or total loss of vision.
- If the DSEK operation fails, the operation can be repeated with another button of donor endothelium.
- If the DSEK fails, a traditional corneal transplant can be done.
Talk to your surgeon at NSES to learn more about our revolutionary DSEK procedure and whether it can improve your vision.