Descemet’s Stripping Endothelial Keratoplasty (DSEK) is one of the more recent techniques in corneal transplantation. A DSEK procedure is a partial-thickness corneal transplant that replaces only the endothelial layer. This advanced technique, where appropriate, is a significant improvement over the standard corneal transplantation operation. The surgery itself takes less time with an experienced eye surgeon, involves a smaller surgical incision, requires far fewer stitches, heals faster and more reliably, and the vision returns faster.
DSEK Benefits
There are several advantages to the DSEK operation compared to standard corneal transplant surgery. Since only the thin inner layer of the cornea is replaced, over 90% of the patient’s own cornea remains behind contributing to greater structural integrity and may reduce the incidence of rejection. The smaller incision offers several benefits over traditional methods of corneal transplant such as Penetrating Keratoplasty (PKP). Because the procedure is less invasive, DSEK leaves the eye much stronger and less prone to injury than full-thickness transplants. Additionally, DSEK has a more rapid rate of visual recovery. Vision is typically restored in one to three months rather than one to two years.
Who are candidates for DSEK?
Only patients with endothelial cell problems are candidates for DSEK. Patients with corneal scarring or other conditions will still require the full-thickness corneal transplantation procedure. There is a risk of the thin button of endothelium becoming displaced within the first few days or weeks after surgery and requiring a return trip to the operating room to reposition it, or the operation can be repeated with another button of donor endothelium. If the DSEK fails, either after one or multiple attempts, a traditional corneal transplant operation can still be performed.
Frequently Asked Questions (FAQs) About DSEK
What is DSEK?
Descemet’s Stripping Endothelial Keratoplasty (DSEK) is a partial corneal transplant that treats eye diseases within the endothelium (inner corneal layer.) It involves replacing the damaged back layer of the cornea with healthy donor tissue while leaving the remainder of the cornea intact.
What conditions are treated with DSEK vs. corneal transplant?
DSEK is used for conditions that damage the corneal endothelium but leave the rest of the cornea healthy. Examples include:
- Fuchs’ endothelial dystrophy
- Pseudophakic bullous keratopathy
- Iridocorneal endothelial syndrome
- Failed previous corneal transplants (when the failure is limited to endothelial decompensation)
In these cases, the cornea’s outer layers remain clear and structurally sound. Instead of removing the whole cornea, DSEK allows selective replacement of the dysfunctional inner layer.
How long does it take for vision recovery after DSEK?
Vision recovery after DSEK usually takes one to three months. Most patients notice enhanced visual clarity within the first month, although full vision stabilization could take up to six months. The timeline may vary based on the patient’s age, other eye conditions, and how well the graft heals. Although vision may not be perfect immediately, DSEK generally results in significantly quicker vision recovery than full-thickness corneal transplants.
Is DSEK safer than traditional corneal transplant surgery?
DSEK is considered safer than a full corneal transplant in many cases. Since it involves a smaller incision and preserves the eye’s natural strength and structure, the risk of complications such as infection and irregular astigmatism is reduced. Additionally, fewer sutures are needed—or sometimes none—which lessens the chance of suture-related problems and inflammation.
Will I need stitches or an overnight hospital stay with DSEK?
In most cases, DSEK can be done on an outpatient basis, so no overnight hospital stay is needed. The procedure typically involves a small incision that may not require stitches. Instead, an air bubble temporarily holds the graft in place.
Patients are usually asked to lie flat for several hours following surgery so the air bubble can help secure the graft.
What happens if a DSEK transplant fails or is rejected?
As with any transplant, graft rejection is a possibility, though it is less common with DSEK than with full corneal transplants. Signs of rejection include:
- Redness
- Blurry vision
- Sensitivity to light
- Eye pain
If rejection occurs, it can often be treated successfully with anti-inflammatory eye drops. However, a repeat DSEK or a full thickness corneal transplant may be required if the graft fails entirely.
How is DSEK different from DMEK or PKP procedures?
There are a few key differences between DSEK, DMEK, and PKP:
- DSEK involves transplanting a thin layer of donor tissue that includes the endothelium and a small portion of the stroma.
- DMEK uses an even thinner graft, made up only of Descemet’s membrane and endothelium, which may lead to better visual outcomes but is technically more challenging.
- PKP (Penetrating Keratoplasty) is a full-thickness corneal transplant. It replaces all layers of the cornea and requires more stitches and a longer recovery.
While DMEK may offer better visual clarity, DSEK remains a widely used and effective option with a lower risk of complications during surgery.
DSEK in Fredericksburg and Culpeper, VA
If you’re wondering whether you’re a candidate for DSEK, call Vista Eye Specialists in Fredericksburg or Culpeper at 540-208-5827 to schedule an appointment with Dr. Jani now.
