Descemet’s Stripping with Endothelial Keratoplasty (DSEK) a newer cornea transplant technique that replaces only the damaged cell layer instead of replacing the entire thickness of the cornea. With this technique cornea heals much faster and stronger and the patient’s visual recovery is better. Because this technique leaves a smoother surface and significantly improves the visual results, it has become a preferred method for treatment for Fuchs’ Dystrophy and pseudophakic bullous keratopathy.
The DSEK procedure can overcome many of these problems associated with a standard corneal transplant. With a DSEK procedure only the abnormal inner lining of the cornea is removed. A thin, circular disc is then removed from the inner lining of a donor cornea. This is folded and placed inside of the eye where an air bubble pushes it in place until it heals in an appropriate position. No sutures are required and the structure of the cornea remains intact, leading to a faster visual recovery and less astigmatism.
The DSEK procedure is done under local anesthesia and takes approximately 45 minutes. For the first 24 hours after surgery you will be asked to lie on your back with your face pointed directly to the ceiling for as much time as you can tolerate. This will help the graft stay in position as the air bubble holds it up into place on your cornea. You will be given several drops to use to prevent infection as well as to help the eye heal comfortably. After the first 48 hours there are minimal restrictions to your activities. The vision is usually better within one week. 80% of the healing has taken place by one month but the vision can continue to slowly improve over the next four to six months.
Penetrating Keratoplasty (PKP) involves replacing an eye’s scarred, diseased or damaged cornea with clear corneal donor tissue. This procedure can improve visual acuity as it is replacing the cloudy cornea with clear donor tissue.
PKP is suitable for those with for corneal decomposition, corneal dystrophies (other than keratoconus) including Fuch’s Dystrophy, and corneal trauma/corneal scarring.
The donor cornea is prepared to create the corneal “button.” The corneal button will become the transplanted cornea. The diseased, or scarred, cornea is then removed, creating a “bed” for the transplant cornea. Finally, the donor cornea is gently sewn into place with ultra-fine sutures (approx. one-third the thickness of human hair, or less). Stitches are typically removed at one year.
Postoperatively, patients should expect very gradual recovery of vision. In fact, the best vision may not be obtained for six to 12 months or more following surgery, even though vision may be improved from the first day after surgery in some cases.