What is DSAEK?

Descemet’s Stripping Automated Endothelial Keratoplasty (DSAEK)

The cornea, the transparent front “window of the eye”, is responsible for about two thirds of the focusing power of the eye.  The cornea’s refractive power is actually greater than that of the eye’s lens.

The cornea receives its nutrients through the tear film.  A normal, healthy cornea should be transparent, thus devoid of blood vessels and opacities.  Corneal tissue can become damaged through disease or trauma.  This damage can cause scar tissue and opacities in the normally-clear cornea, resulting in a reduction in visual acuity.

If the cornea develops visually significant opacities or irregularities, a corneal transplant, or DSAEK procedure can be performed.

dsaek cornea before and after picturesWhat is DSAEK

Descemet’s stripping automated endothelial keratoplasty (DSAEK) involves surgically replacing diseased cornea tissue with donor cornea tissue.  Instead of the entire cornea being removed and replaced, only the damaged layer of tissue is replaced, making DSAEK a much less invasive option than the traditional method of total corneal transplantation.

This less invasive procedure leads to rapid recoveries and reduces the risks of sight threatening complications like hemorrhaging, infection and wound rupture.

Who is a candidate?

DSAEK is a preferred surgical procedure over corneal transplant, but it is not for everyone.  Only those corneas with defects and damage limited to the inner cornea layer (endothelium) are candidates for DSAEK.  Eyes with corneal scars are not good candidates for DSAEK and will be considered for full corneal transplant surgery.

A common disease that can cause damage to this inner layer of the cornea is Fuchs’ Corneal Dystrophy.  This inherited eye disease causes the cornea to swell, opacify and distort vision.

The surgical procedure

DSAEK is an outpatient procedure.  No hospitalization is required.  The entire surgery, including prepping the eye, usually takes between 45 and 60 minutes.

After the eye is cleaned and prepared with a sterile drape, a small incision is made at the edge of the cornea.  Through this tiny incision, the diseased inner layer of cornea is peeled away and removed.  The donor cornea’s inner layer is separated from the other layers with a precision machine called a microkeratome.  This ultra-thin “button” of cornea is then carefully folded and inserted into the eye through the incision and attached to the back, inner “dome” of the cornea.  The donor tissue is then held in place with an air bubble until it adheres to its new place in the patient,s eye, usually in about 24 hours.

The small incision is then secured with one small suture.

Recovery time

In most cases, the vision will begin to improve in about one week.  Full recovery is typically 3 months.

What are the differences between DSAEK and Corneal Transplant?

Penetrating Keratoplasty
(full thickness traditional cornea transplant)
DSAEK
(partial thickness posterior cornea transplant)
Typical time for visual improvement 6-12 months 4-6 weeks
Visits for suture adjustment 6-12 visits 2-3 visits
Time of surgery 45-60 mins. 45-60 mins.
Wound size 7.5 mm diameter circle 5 mm linear
Sutures 16 2-4
Contact lens required Rigid gas permeable (often) Not required
Induced astigmatism High regular and Irregular astigmatism possible Minimal to no induced astigmatism
Indications for surgery Cornea scar, keratoconus, pellucid marginal degeneration, corneal ulcer Fuch’s endothelial dystrophy, cornea edema, pseudophakic bullous keratopathy