DSEK is a relatively new form of corneal transplant surgery that was developed in the late 1990’s and became a common tool of fellowship-trained corneal specialists beginning in 2005. Whereas traditional corneal transplant surgery (penetrating keratoplasty) replaces a patient’s entire cornea with a new donor cornea, in DSEK only the back portion of the cornea is replaced.
The back of the cornea is called the endothelium, and the endothelial lining is responsible for the transport of fluid throughout the back of the cornea to maintain the cornea’s transparency. When the endothelial lining is damaged, either through Fuch’s dystrophy or trauma from surgery, the endothelium experiences a gradual loss of cells which in turns reduces vision.
If the outer surface of the cornea is not damaged, as is often the case with Fuch’s dystrophy, then replacing only the back of the cornea through DSEK can lead to a more rapid recovery and stabilization of vision than by full-thickness corneal transplant surgery (penetrating keratoplasty). In September 2009, the American Academy of Ophthalmology issued a report indicating that based on their review of over a decade of research studies:
“DSEK was superior to penetrating keratoplasty (PK)–the dominant procedure prior to DSEK’s development–in terms of earlier recovery and stability of vision, refractive status after surgery, and specific risks and complications associated with surgery and recovery. The most common DSEK complications apparently do not hinder ultimate recovery of vision in most patients. DSEK and PK outcomes were similar in terms of survival of the transplanted cornea, visual sharpness (acuity) and endothelial cell loss, and specific surgical risks and complication rates.”
Dr. Michael Halsted and Dr. Michael Feilmeier of Midwest Eye Care are both accomplished DSEK surgeons and have had outstanding surgical outcomes with this procedure.
The animation below provides an overview of DSEK.