DSAEK is a new technique that appears to have significant improvement over the standard corneal transplant. With DSAEK, a thin piece of donor tissue containing only the endothelial cell layer is inserted onto the back surface of the patient’s cornea. The surgery itself takes less time, involves a smaller surgical incision, requires far fewer stitches, heals faster and more reliably, and the vision returns faster.
There are several advantages to the DSAEK operation compared to standard corneal transplant surgery. The wound is smaller and closer in size and location to a cataract surgery incision. The smaller wound is more stable and less likely to break open from trauma. Because the wound is smaller and requires far fewer sutures, there is very little postoperative astigmatism which can delay the visual recovery. The maximum return in vision takes only about 3 to 4 months following DSAEK. 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.
Only patients with endothelial cell problems are candidates for DSAEK. Patients with corneal scarring or other conditions will still require the full-thickness corneal transplant procedure. Since corneal specialists have only been performing DSAEK for a short while, there are no long-term follow-up studies. 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. If the DSAEK operation fails, the operation can be repeated with another button of donor endothelium, or a traditional corneal transplant operation can always be performed.