Descemet's Stripping Automated Endothelial Keratoplasty (DSAEK)

DSAEK is a new technique that can help some patients who previously required a full thickness corneal transplant. Both the conventional corneal transplant technique and DSAEK require use of a donor cornea, but DSAEK replaces only the damaged posterior section of your cornea. This procedure, which requires minimal suturing, allows more rapid visual restoration, less discomfort, and a reduced risk of sight-threatening complications.

The cornea is the clear window at the front of the eye that bends and helps focus light onto the back of the eye (the retina). In order for vision to be clear, the cornea must be clean and clear. Corneal disease can cause the cornea to become swollen, opaque or cloudy, preventing light from passing through clearly.

With a conventional corneal transplant, the full thickness of the cornea is completely removed, and a whole new donor cornea is sutured around the circumference of the cornea. These sutures can remain in the eye for over a year and often cause the cornea to take on an irregular shape during the healing process that may be difficult to correct with glasses or contact lenses. This results in less than optimum postoperative vision. DSAEK, on the other hand, involves removing only Descemet's membrane (the inside lining of your cornea) and the damaged endothelial cells and leaves the surface of the cornea untouched. The surgery is usually performed on an outpatient basis.

What to expect on surgery day

It is important to understand that your eye needs to be pointed up at the ceiling for about 48 hours after surgery, so we will want you lying in bed or in a recliner chair when you get home.  You will not be able to do most of your daily activities until the transplant surgery is secure after that period.  It will be very helpful to have assistance arranged in advance for preparing your meals and caring for your typical chores for those few days after surgery while you need to avoid activities. 

You will arrive at the surgery center about an hour prior to your procedure. Once you have been checked in you may be offered a sedative to help you relax. You will then be prepared for surgery. The area around your eyes will be cleaned and a sterile drape will be applied around your eye.

A small incision will be made to allow the surgeon to strip away Descemet's membrane and your damaged endothelial cells. Next, the inside 10-20% of a donor cornea that has healthy endothelial cells attached to its Descemet's membrane will be inserted through the same incision. After it is placed in position, an air bubble will be used to hold the transplanted tissue in place.

After your DSAEK procedure

Immediately after the procedure, you will be taken into a recovery area where you will lie down with your eye looking up at the ceiling for about an hour to let the air bubble to hold the transplanted tissue in the correct position to seal it securely in place. Your eye will be covered with a protective shield before you leave. Antibiotic eye drops will be used for a few weeks to help prevent infection, and a mild steroid eye drop will need to be used to help with healing and to reduce the risk of transplant rejection.

When you go home, we want you to continue to lie on your back looking up at the ceiling as much as possible for the next 48 hours.  You should be able to resume normal activities 2 days after your surgery as by that time your body will absorb the air bubble that was used to hold your transplant in place. With full thickness corneal transplantation, your vision typically does not improve for months or even a year or more, while with DSAEK, we expect you to experience visual improvement within several weeks. If you need transplants in both eyes, DSAEK allows you to have the second transplant within months, versus a year or more if you were to have a full thickness transplant.

In order to make your DSAEK procedure a success, it is important that ALL scheduled appointments be kept and ALL medications are used as directed. Any pain, redness, or reduced vision should be reported immediately.

Realistic expectations

The decision to have DSAEK is an important one that only you and your doctor can make. The goal of any vision restoration procedure is to improve your vision. However, we cannot guarantee you will have the results you desire. Rejection could happen (although rarely) at any time in the future. However, if the transplanted tissue should be rejected, it is usually possible to have the procedure successfully repeated.