The cornea is made of five layers. The corneal endothelium is the inner most layer and helps keep the cornea clear by pumping water out of the stroma and keeping the level of water stable throughout the day and night. This layer is essential to keep the cornea a certain thickness and the vision clear.
Sometimes, the inner layer gets sick or diseased. For example, in Fuch’s Corneal Dystrophy, disease that is sometimes hereditary, the cornea endothelium gets sick and the cell count of the endothelium starts to decline at an early age. This early cell loss can sometimes be exacerbated by trauma or surgery, no matter of how perfectly the surgery went.
When the corneal endothelium can’t keep up with what it is supposed to do and the pump mechanism slowly fails, this can cause corneal edema which can lead to cloudy vision that can sometimes be cleared by drops and other therapies, but often requires surgery to fix the root of the problem.
What is a DSAEK?
A DSAEK procedure is a partial-thickness corneal transplant that replaces only the inner portion of the cornea containing the endothelial layer. A thin piece of donor tissue is inserted onto the back (inner) surface of the patient’s cornea. This involves a smaller surgical incision, requires far fewer stitches, heals faster and more reliably, and allows for a faster visual recovery. Hence, the vision may clear up more quickly.
Advantages of a DSAEK versus a Full Corneal Transplant
There are several advantages to the DSAEK operation compared to standard corneal transplant surgery.
They are (amongst others):
- The surgery itself takes less time when performed by an experienced physician.
- The wound is smaller and closer in size and location to a cataract surgery. As such, it is more stable and less likely to break open from trauma.
- There is less residual post-operative astigmatism (abnormality of the shape of the cornea) after surgery
- Visual recovery time is significantly faster with a DSAEK (as little as a few weeks to a couple of months)
- May decrease incidence of rejection.
- Greater structural integrity
- 90% of patient’s own cornea is still in place after surgery.
However, only patients with endothelial cell (inner most layer) problems are candidates for DSAEK. Those with problems with scarring or clouding of other parts of the cornea may not be candidates for a DSAEK and may do better with a full thickness corneal transplant. This is something your doctor will talk to you about after he or she examines you.
There are many factors to consider when considering a DSAEK, as well as possible unique risks when considering this state-of-the-art procedure. Moreover, since it is such a new procedure that is currently undergoing refinement, ongoing research is looking at the long-term effects of this more novel type of surgical procedure.
We are privileged to have a surgeon who performs DSAEK, Dr. Thomas Gillette, one of the pioneers of DSAEK in the Seattle area.
Schedule an evaluation of your corneal procedure, in order to find out which one is right for you to improve your vision.