Until recently, the only way to replace the endothelium was with full thickness corneal transplant which required multiple sutures. A split thickness transplant called endothelial keratoplasty has recently become the standard of care for many corneal diseases. In this procedure, the back portion of the split donor cornea is used to replace only the diseased endothelial portion of your cornea, leaving the rest of your cornea intact. The device used to prepare the donor tissue is very similar to that used in LASIK. The formal term is Descemet’s Stripping Endothelial Keratoplasty or DSEK.
Split-thickness corneal transplants have been done for many years to replace the front part of the cornea and they have been highly successful. This procedure is different because the surgical procedure involves replacement of the back layers of the cornea rather than the front layers. This replacement is done through a small pocket incision to avoid changes in the front surface of the cornea. An air bubble is used to hold the new layer against the back of the old cornea. After 36 hours or so the air is naturally absorbed leaving the two fused together. By leaving the front surface of the cornea without sutures or large incisions, the healing and recovery time for the patient is quicker, more comfortable and safer.
Benefits of DSEK
Patients who have a DSEK have been shown to have a smoother corneal surface than patients that have a full-thickness standard corneal transplant. This happens because the natural surface of the cornea is not replaced so the focusing power of the cornea remains more natural and therefore more stable than with a full-thickness corneal transplant. Therefore, there is less of a chance of you needing thick glasses after a split-thickness transplant when compared to a full-thickness corneal transplant.
Patients who have a standard full-thickness corneal transplant need either 16 sutures or one long looping suture, all of which cause more discomfort and more irregularity to the surface than has been shown with the split-thickness transplants.
Fewer follow-up exams are necessary because there are no corneal stitches to be removed.
Corneal transplant rejection is less likely with DSEK than conventional transplants.
Visual recovery is faster with DSEK.
Like conventional corneal transplantation, DSEK surgery is covered by most major insurance carriers, including Medicare. DSEK is not appropriate for all patients with corneal disease.
Our surgeons and medical staff carefully review the latest findings and outcomes of all advanced treatments to ensure they meet rigorous standards for quality and safety before considering them as treatment options for our patients.