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Descemet’s Stripping Automated Endothelial Keratoplasty (DSAEK)

What is corneal edema or Fuch’s dystrophy?


Corneal edema (swelling) produces decreased vision due to loss of transparency of the normally clear tissue on the surface of the eye. This results from dysfunction of the endothelium, a thin layer of cells on the most posterior aspect of the cornea. These cells are not capable of dividing or repairing themselves. The only treatment for visually significant corneal swelling is to replace the cells.

In the past the gold standard for replacing endothelial cells would be to perform a corneal transplant. We have provided you a handout which covers the risks and benefits of this procedure in a comprehensive manner. Corneal transplantation requires a full-thickness incision of the cornea and replacement with a complete new cornea. It is sutured in place with very fine stitches which are left in place for years to maintain the stability and curvature of the cornea. If the stitches break, it feels like there is sand or lint in the eye and the curvature of the cornea can change causing the vision to change and requiring new glasses. In addition, the broken stitches may produce a corneal infection requiring the use of antibiotics to treat the infection and rarely can lead to the loss of the graft. It is very difficult to predict the final curvature of the cornea; so after the surgery glasses or contact lenses may be required to obtain your best vision.

The benefit of the corneal transplant is that it is thin and clear and provides excellent vision with the appropriate glasses or contact lenses. It has been the standard of care for many years and most physicians are very familiar with the care of the operation.

What is DSAEK surgery?

However, recently a new procedure called DSAEK has been developed to replace the endothelial cells and posterior stroma and it is placed in the eye through a small incision on the side of the eye. This tissue adheres to the back surface of the old cornea and clears the corneal swelling.


What are the advantages and disadvantages of DSAEK surgery?

The advantages of DSAEK is that extensive stitching of the cornea is not required, the eye is able to heal more quickly, and the anterior corneal curvature is maintained. Although glasses will still be required, they may be much thinner and the power of the eye after surgery is much more predictable. In addition, the surgery is safer as the whole eye does not have to be opened reducing the chance of devastating hemorrhage or infection. As there is not a full thickness replacement of the cornea, the eye is left much stronger so that if the eye was struck there would be less likelihood of serious injury.

The disadvantages of the DSAEK procedure is the cornea is left thicker than original due to the addition of tissue to the posterior aspect of your current cornea. This may make it more difficult to follow glaucoma. Further, although the vision is much better than before the operation, ultimately it may not be as crisp as a full thickness corneal transplant. Many patients like the DSAEK operation, even with slightly worse vision because they do not need thick glasses afterward and can see better without glasses than in full-thickness corneal transplantation.

What type of restrictions will there be after surgery?

In order to make the new tissue stick onto the back of the old cornea, an air bubble is used to completely fill the front part of the eye for an hour after surgery. After that time the air bubble is partially released and left overnight. During that time it is important to stay on your back as much as possible to keep the air bubble positioned correctly, anchoring the new tissue in place. When you are seen the next day the position of the new tissue will be checked. It may be necessary at the appointment or the following appointment the next week to reposition the new tissue by placing a new air bubble. Once the tissue sticks, it remains in place so the most critical time is the first two weeks. If the tissue does not stick or the DSAEK fails, then a traditional cornea transplant can be performed.

What can I expect after DSAEK surgery?

After DSAEK the vision clears faster than the standard corneal transplant operation and you return to your normal activities within two weeks, with the exception of swimming. Like corneal transplantation, eye drops are required for at least a year and more often for the rest of your life to prevent graft rejection, where the body recognized the tissue as being foreign and can react against it. Fortunately graft rejections are very unusual (less than 10% of the time) and if they do occur, they can be treated successfully in the majority of cases with frequent eye drops and occasionally oral medications. The cornea is a privileged site where powerful immunosuppresive medications are rarely necessary to prevent graft failure.

We are pleased to bring this new procedure to Syracuse and look forward to working with you to help improve your vision.
If you have any questions please do not hesitate to contact us at (315) 445-1577.