DSEK – Partial Thickness Corneal Transplant
Descemet Stripping Endothelial Keratoplasty or DSEK is a partial thickness corneal transplant that was first described in 2004. Since that time, DSEK has proven to be very successful and was quickly adopted by corneal surgeons across the world.
It is indicated for patients with corneal edema after cataract surgery or endothelial dysfunction such as Fuchs endothelial dystrophy. DSEK can be performed in patients with other eye diseases such as macular degeneration or glaucoma as well.
During DSEK, the deteriorated endothelial cells are removed from the patient’s eye along with the Descemet’s membrane. A thin partial thickness corneal transplant from a donor is inserted into the eye, and the patient keeps most of the outer layers of their own cornea. The transplanted tissue is pressed against the patient’s own cornea with an air bubble injected into the eye. The patient must lay flat on their back as much as possible until the air bubble is absorbed after approximately 2-3 days. Some patients may require a second air bubble to be injected in the eye in the office or in the operating room to help with adhesion.
In contrast to PKP, DSEK only requires 1 suture which is removed within 1 month. The visual recovery is much faster than PKP. Patients on average reach their full visual potential in approximately 3 months. The final visual acuity is usually better than PKP, and DSEK avoids the irregular astigmatism sometimes associated with PKP. DSEK can be combined with cataract surgery. The rate of rejection is though to be lower in DSEK compared to PKP, but patients must still remain on steroid eye drops for a few years after surgery to avoid rejection of the transplant.