Video: The Cornea & DSAEK
Several diseases can effect the cornea, or clear covering of the eye, such as Fuchs Dystrophy, which causes cloudy vision, and Keriticonus, which creates distortion through extreme astigmatism. Surgery can correct some conditions, but in some cases, a corneal transplant is needed. DSAEK is a new, advanced technique that uses a small, suture-less incision to remove just the back layer of the cornea. This provides great results with a much faster recovery time than in traditional cornea transplant surgery.
How is DSAEK Different from Full Transplants?
The DSAEK technique involves peeling off only the inner two layers of your cornea (ie Descemet's Membrane and Endothelium). This allows replacement of the diseased posterior or inner layers of your cornea while preserving the remaining healthy cornea. In this way, patients retain 80% of their natural cornea and replace only the 20% that is diseased. The back surface of a donor cornea that has been pre-cut to the desired thickness and diameter is then folded and inserted through a small incision into the front fluid chamber of the eye. Once inside, the donor is carefully unfolded and floated up against the back of your cornea with an air bubble. You will be asked to recline or lay flat for about 36 hours in order for the air bubble to float to the top and hold the donor tightly against your cornea. With good compliance with this requirement, the donor cornea typically adheres to back of your cornea without the need for sutures.
Advantages & Disadvantages of DSAEK
- A smaller wound is made and fewer sutures are needed. Because of this, the eye heals faster and vision can return in 1-3 months instead of up to a year or more after a standard transplant.
- The eye is also less susceptible to injury and rupture after DSAEK compared to a standard corneal transplant.
- Surgical safety is much higher due to the small incision with greatly reduced risk of sight threatening complications. In some cases, sutures can lead to problems with infection or irritation to the eye after standard corneal transplantation. These problems should be greatly reduced with DSAEK.
- Early indications show that there is less risk of transplant rejection with DSAEK compared to standard corneal transplant.
- Stability in your eye's prescription is much better. After DSAEK, one’s prescription for glasses may be similar to what it was prior to surgery but we often see a slight shift towards hyperopia or farsightedness. However, after standard corneal transplantation, patients can end up with large changes in the amount of astigmatism, nearsightedness or farsightedness compared to what they had before.
- DSAEK is much less invasive than full corneal transplants and thus has less potential complications.
- The most common problem that is encountered is that the donor cornea may dislocate or fail to attach to your own cornea. This would require additional surgery to correct; namely re-injection of another air bubble and/or possibly placement of sutures to hold the donor in place. As techniques have improved, this occurs in less than 10% of cases of DSAEK.
- In a very small number of cases, the donor cornea is incompatible or simply does not clear. If the donor fails to clear by 90 days after DSAEK, then a repeat DSAEK with a replacement donor is indicated.
- Rarely, haze, swelling or scarring occurs between the layers of the donated cornea and your own cornea which causes decreased vision and could necessitate a full thickness corneal transplantation to improve your vision.
- Finally, patients should ideally have had their cataracts removed prior to DSAEK but this can also done at the same time with DSAEK as a combined procedure. In the occasional younger patient who does not have a cataract, damage could occur during DSAEK surgery to the natural lens to either speed up or cause the development of a cataract (this can also occur during a standard corneal transplantation).
What to Expect on Your Surgery Day
Post-op Care of Your DSAEK
Risks of DSAEK Surgery
- Hemorrhage or bleeding
- Problems with healing
- Anesthesia complications
- Complications of surgery in general
- Risks associated with any eye surgery: Glaucoma, Cataract Formation
- Corneal transplant rejection
- Displacement of donor disc
- Failure of the donor tissue to clear
- Recurrence of pre-existing disease
- Induction of astigmatism