Patient Information – DSEK
Descement – Stripping Endothelial Keratoplasty
The cornea is the front window of the eye. A healthy, clear cornea is necessary for perfectly clear vision. Some diseases of the cornea only affect the inner lining of the cornea. For these diseases, a new procedure, DSEK, is able to restore vision.
Prior to January 2007, patients with corneal diseases in Las Vegas required a full thickness corneal transplant in order to improve vision. Since January 2007, Dr. DeBry has been offering the DSEK to his patients with corneal endothelial diseases such as Fuchs dystrophy. This new procedure has significant benefits compared to the older, full thickness corneal transplant procedure.
A full thickness corneal transplant removes a circular disc from the center of the cornea. A healthy, clear donor cornea is obtained from a person who has died from a car accident or other medical condition. This donor cornea then has the central circular area removed with a similar shape. The new cornea is then put into position and sutured into place. A full thickness corneal transplant is a safe and well tolerated procedure. However, the recovery can be quite long, up to twelve months. It is also not uncommon to have significant irregular curvature of the cornea because of the sutures. In many cases a contact lens is required to achieve the best vision. Finally, a full thickness transplant can have continued weakness even years later such that a minor trauma can dislocate the graft from its position.
The DSEK procedure can overcome many of these problems associated with a standard corneal transplant. With a DSEK procedure only the abnormal inner lining of the cornea is removed. A thin, circular disc is then removed from the inner lining of a donor cornea. This is folded and place inside of the eye where an air bubble pushes it in place until it heals in an appropriate position. No sutures are required and the structure of the cornea remains intact, leading to a faster visual recovery and less astigmatism.
With either procedure there is a risk of rejection, where the body’s immune system starts to fight against the cornea. The symptoms of rejection are redness, blurry vision, and light sensitivity. This can happen at any time months or years after the transplant. A complication that can occur from the DSEK procedure that is not associated with a standard transplant is a graft dislocation, where the circular disc slips from its intended position. In this circumstance the donor disc needs to be repositioned in the operating room.
The DSEK procedure is done under local anesthesia. The patient is brought to the operating room in an ambulatory surgery center. Relaxing medications are put in the vein and numbing injections placed around the eye. The procedure takes approximately 45 minutes. For the first 24 hours you will be asked to lie on your back with your face pointed directly to the ceiling for as much time as you can tolerate. This will help the graft stay in position as the air bubble holds it up into place on your cornea. You will be given several drops to use to prevent infection as well as to help the eye heal comfortably. After the first 48 hours there are minimal restrictions to your activities. The vision is usually better within one week. 80% of the healing has taken place by one month but the vision can continue to slowly improve over the next four to six months.