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What is DSEK?

Descemet’s Stripping Endothelial Keratoplasty or DSEK is a procedure used to correct corneal edema. The cornea is the front portion of the eye which contains cells that allow for fluid to pass in and out of the cornea. When these cells are damaged, fluid can build up and cause corneal edema or swelling of the cornea. These cells will not heal themselves and have to be replaced.

DSEK is 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.

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.

Advantages of DSEK:

  • The eye is left much stronger and more resistant to injury
  • There is minimal change in refractive error because the patient’s cornea is essentially intact
  • Suture-related problems can be eliminated
  • Lower transplant rejection rate compared to full corneal transplant
  • Visual recovery is significantly faster and better
  • Less downtime from work and normal activities of daily living compared to corneal transplant