An innovative procedure known as DSAEK is getting high marks from our doctors at the Cornea and Laser Vision Institute. Until recently, cornea transplant patients in the St. Louis area had very few treatment choices if they ever wanted to see clearly again. The most likely option was to undergo full thickness corneal transplant – a complicated procedure that surgically replaces the entire damaged cornea with a donor cornea.
Short for Descemet’s Stripping Automated Endothelial Keratoplasty, DSAEK (pronounced de-sak), is not nearly as invasive, and requires considerably less recovery time. Rather than removing your entire cornea, our cornea specialists make a small incision in the side of the eye and replace only the damaged portion at the back inner dome of the cornea with donor cells. DSAEK uses the innovative instrumentation designed for LASIK. The donor cornea is prepared using the LASIK instrumentation to create only a thin layer of tissue to transplant. This thin layer contains a new healthy layer of pump cells. The surgeon then delicately pushes the new cells in place with a bubble of air. It’s like replacing the wallpaper instead of replacing the wall. During the first twenty-four hours, 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. The transplanted cells begin pumping fluid out of the cornea, thus creating a suction that causes them to adhere to the back of the host cornea.
We’re excited about DSAEK at our practice. Rather than facing a potential one-year recovery period (a huge drawback for full thickness corneal transplant patients), the healing time is mere months for DSAEK patients. Another benefit: the procedure involves little or no stitches. The incision required for the surgery is very small. DSAEK is performed as an outpatient procedure under local anesthesia. The patient can go home after surgery without even having to have an eye patch. Finally, there is also less risk of rejection because the majority of the cornea remains in place.
The main disadvantage of the DSAEK procedure is that the new layer of cells is manipulated more directly than in a full thickness corneal transplantation, potentially producing more damage and possibly resulting in graft failure. There is a 10% chance that the new tissue will not adhere properly requiring repositioning and a new bubble, or in less than 1% of cases, re-operation. The cornea is also left somewhat thicker than the original due to the addition of tissue to your current cornea. This may make it more difficult to follow glaucoma. Antibiotic eye drops will be used for a week or so to help prevent infection, and a mild steroid eye drop will need to be used for long term to help prevent rejection.
1 day after surgery with air bubble holding new cornea in place
The results of corneal transplantation are excellent, but as you can see, it takes a long time to heal. That is why it is such a wonderful thing to be able to replace full thickness corneal transplantation with the new partial thickness DSAEK procedure. This is now an option for many who would otherwise have been limited to a full thickness transplant. Although DSAEK is one of the most sophisticated and precise microsurgical procedures performed by an eye surgeon, as far as the patient is concerned, a big procedure has now been replaced by a much simpler, outpatient procedure that allows you to return to normal activities and restores your vision sooner.