Descemet’s Stripping Endothelial Keratoplasty (DSEK)

Indications

Decreased vision related to corneal swelling from a poorly functioning endothelium, usually due to Fuchs dystrophy or after cataract or another ocular surgery.

Procedure

DSEK involves removing the damaged endothelial cells and Descemet’s membrane and replacing it with partial thickness graft including donor endothelium and Descemet’s membrane. This surgery is performed through a small incision, requiring that the graft be folded or rolled to get it into the eye. It is then held into position with an air bubble for a period of time, after which (most of the time) it adheres.

Advantages: include a small incision with few sutures, faster visual recover than after full thickness corneal transplantation, and minimal change in astigmatism or post-operative refraction.

Disadvantages: include the fact it is newer, somewhat tricky surgery and that the graft occasionally does not adhere and further surgery is required. DSEK is performed using local or general anesthesia in the operating room.