Choose the content to read
- Why DSAEK?
- What causes corneal endothelial dysfunction?
- What are the symptoms of corneal endothelial dysfunction?
- What diseases does DSAEK treat?
- What is the DSAEK corneal transplant procedure?
- What is the advantage of DSAEK?
- What is the success rate of DSAEK?
- DSAEK Corneal Transplant at MedPark Hospital
DSAEK Corneal Transplant
DSAEK (Descemet's stripping automated endothelial keratoplasty) is a partial-thickness corneal transplant procedure that involves removing only deteriorated or diseased endothelial corneal layers and replacing them with a partial-thickness donor cornea containing healthy endothelial layer. DSAEK corneal transplant is suitable for individuals with abnormalities in only Descemet’s membrane and endothelium (layers 4-5) but a healthy anterior cornea (layers 1-3). The ophthalmologist will use anterior air bubble pressurization techniques to push the inner cornea against the outer cornea. As the corneal tissue cells gradually merge, the Descemet's membrane and endothelium slowly suck out water from the cloudy cornea, allowing the cornea to become clear, reducing swelling, and restoring clear vision.
Why DSAEK?
In the past, ophthalmologists used full-thickness cornea transplants (penetrating keratoplasty: PKP) to treat corneal edema from an iridocorneal endothelial syndrome, Fuchs’ endothelial corneal dystrophy, congenital hereditary endothelial dystrophy, or posterior corneal scarring caused by infection or injury abnormalities. This resulted in large, slow-healing corneal wounds, took a long visual recovery period, affected vision acuity and had a higher rate of suture-related infection.
DSAEK removes only the posterior cornea layers 4-5 and transplants a thin sheet of healthy donor corneas through a 3-4 mm side incision, preserving the remaining healthy anterior cornea layers, requiring no wound stitching between donor and cornea, shortening recovery time, lowering the risk of graft rejection, decreasing the risk of surgical wound infection, enabling a stronger cornea while reducing the risk of serious complications, and restoring vision quickly.
What causes corneal endothelial dysfunction?
- Aging
- Genetics
- Eye injury
- Trauma after ocular surgery
- Corneal endothelial disease or abnormalities.
- Corneal scarring from infection or injury.
What are the symptoms of corneal endothelial dysfunction?
- Blurred vision, inability to see things clearly
- Fluctuation in vision, typically worse in the morning and improving toward the end of the day
- Dim-brightness vision or reduced contrast sensitivity
- Light sensitivity
- Have glare or have difficulty with nighttime driving
- Eye discomfort, eye pain
- Eye irritation, recurrent foreign body sensation in the eye
What diseases does DSAEK treat?
DSAEK treats the inner corneal layers, including Descemet's membrane and endothelium, that have damaged due to diseases or abnormalities, as follows:
- Fuchs' Endothelial Corneal Dystrophy
- Iridocorneal Endothelial Syndrome
- Bullous Keratopathy
- Corneal edema due to complications of eye surgery
- Congenital hereditary endothelial dystrophy
- Posterior corneal scarring due to infection or injury
- Failed graft
Diagnosis fore DSAEK corneal transplant
The ophthalmologist will perform the following assessment steps in order to determine the patient's suitability for corneal transplant using the DSAEK technique: obtain a medical history, perform a thorough eye examination with slit lamp biomicroscope, and perform further investigations, including specular microscopy, pachymetry, and anterior segment optical coherence tomography.
DSAEK corneal transplant procedure
Preoperative DSAEK corneal transplant
- When an ophthalmologist determines the patient is a good candidate for a DSAEK corneal transplant, the hospital immediately places the patient on a waiting list to receive corneal donations from the local eye bank. In cases of urgency, the hospital may consider purchasing and importing donated corneas from abroad instead.
- Once a donor corneal is confirmed from the eye bank and the corneal is qualified and healthy, the hospital will notify the patient and schedule the surgery date.
- The ophthalmologist may arrange for you to undergo a laser peripheral iridotomy prior to the scheduled surgery date in order to prevent the risk of postoperative intraocular pressure elevation.
- Prior to the surgery date, the hospital will schedule a physical examination, as follows:
- Blood Tests
- Electrocardiogram (EKG/ECG)
- Chest X-ray
Intraoperative DSAEK corneal transplant
- The ophthalmologist will perform DSAEK corneal transplant surgery by removing the damaged or diseased endothelial corneal layers (layers 4-5) via a small eye-side incision similar to a cataract surgical incision and replacing them with a thin sheet of donor cornea (thin partial stroma Descemet's membrane and endothelium).
- The new cornea will be firmly adhered to the outer cornea by natural eye (intraocular) pressure combined with the air bubble pressure technique, using an ophthalmic microscope to inject air bubbles into the anterior chamber to exert pressure, pushing the inner corneas against the outer corneas. The air bubbles will help support the graft and speed up the wound's healing process without stitching the corneas. The air bubbles will gradually absorb and disappear in 3–4 days, or maybe longer if using gas. Typically, DSAEK corneal transplant takes approximately 1 hour, depending on the complexity of each patient and any concurrent operations.
Postoperative DSAEK corneal transplant
- After the surgery is complete, the ophthalmologist will cover the eyes with eye pads and eye shields.
- The ophthalmologists and nurses will closely monitor the symptoms for the first hour after surgery.
- The patients must lie supine for the first hour of recovery. This allows the air bubble to float upward and press the graft against the back of the anterior cornea layers, facilitating its adhesion to the posterior cornea layers.
- Patients are allowed to get up to go to the restroom, stretch their legs, and have meals. However, during the initial few days following surgery, the patient is recommended to lie on their back as much as possible to facilitate the adhesion.
- Typically, the patient will experience blurry vision in the early postoperative period due to the residual air bubble in the eye, which will gradually disappear over the next few days.
What is the post operative care for DSAEK?
- The ophthalmologist will schedule a follow-up appointment the day after the surgery.
- The patient must lie supine for 2–3 days to 1 week after surgery, depending on the remaining volume of air bubble left.
- Cover the eye shield during the day and at night for a minimum of 1 week to prevent the eye from unintentionally rubbings.
- Consistently instill eye drops on time, per the ophthalmologist's instructions.
- Avoid excessive screen time by scheduling screen-free breaks on electronic devices.
- For 1 week, avoid washing your face, rubbing your eyes, or squeezing your eyes.
- For 1 week, refrain from any activities or exercises that may cause sweat to enter your eyes.
- Exercise such as treadmill, or walking are permitted in the first post-surgery week.
- Jogging or weightlifting should be avoided for 3-4 weeks.
- Attending hospital ophthalmologist appointments to monitor symptoms and evaluate treatment outcomes.
What is the recovery time for DSAEK?
DSAEK corneal transplant requires 2-3 weeks to recover and gradually improve noticeably clear vision within 3 months, depending on patient-factor variables, such as disease severity and the duration of postoperative corneal edema. These differ from traditional corneal transplants, which may take several months or even years for maximum restoration of the vision.
What is the advantage of DSAEK?
- Small incision: DSAEK corneal transplant creates a small surgical wound on the side of the eye, only 3-4 millimeters, which accelerates wound healing and recovery.
- No corneal-graft sutures: DSAEK is a sturgical technique that does not require corneal suturing between the graft and the patient's cornea. After the surgery, the corneal graft adheres to the front layers of the cornea by intraocular pressure and air bubble pressure without the need for sutures, which reduces suture-related complications, including infections, or postoperative corneal astigmatism, and postoperative eye irritation.
- Fast visual recovery: DSAEK employs relatively less invasive corneal transplantation, which helps preserve healthy anterior cornea layers, accelerates wound recovery, reduces the risk of corneal astigmatism, and can restore clear vision as little as 3 months post-surgery.
- Low risk of graft rejection: DSAEK employs the posterior corneal layer transplantation technique, which eliminates the need to remove and graft all corneal layers, uses less donated corneal tissue, and eliminates the need to stitch the transplanted cornea to the native cornea, thereby lowering the risk of graft rejection.
- Low risk of sight-threatening complications: DSAEK can be performed through relatively small incisions without requiring the eye to be opened completely, thereby reducing the risk of severe infections and suprachoroidal hemorrhage.
- Preserve the strength of the cornea: DSAEK leaves healthy anterior cornea layers structurally intact and preserves the cornea's strength and natural corneal curvature.
- Immediate disease treatment: DSAEK surgical procedures promptly remove corneal diseases. The newly transplanted cornea will gradually suck water out of the cloudy cornea, allowing the entire cornea to become transparent and restoring vision.
What is the disadvantage of DSAEK?
- Graft rejection: DSAEK is a type of corneal transplant in which the body can reject the transplant. Therefore, the patient must administer the prescribed eye drops regularly and return to see the ophthalmologist at each appointment to monitor symptoms closely. In cases where the ophthalmologist detects early signs of graft rejection, they will treat promptly to head off the rejection of the corneal transplant.
- Graft dislocation or detachment: In case the grafts moves from its designated position. Donor tissue reposition is easily treated by placing another air/gas bubble in the anterior chamber to keep the transplanted cornea in the specified position.
- Infection: As with any other type of surgery, corneal endothelial keratoplasty can develop infection. However, DSAEK keratoplasty requires small incisions without corneal graft sutures, which reduces the likelihood of this occurrence to less than 1 in 1000 cases.
What is the success rate of DSAEK?
According to the multicenter study's findings, the overall graft success rate for patients undergoing DSAEK corneal transplant surgery at three years is 94%. The patients can achieve corrected distance visual acuity of 20/30 at three months and 20/25 at six months following surgery. This indicates that DSAEK provides a superior visual outcome compared to traditional full-thickness corneal transplants.
What health benefits does DSAEK corneal transplant provide?
DSAEK corneal transplant preserves a healthy anterior corneal layer, shortens recovery time, lowers the risk of graft rejection, reduces suture-related complications, maintains corneal integrity, enables quick vision restoration, enhances vision acuity, restores corneal clarity, and improves quality of life.
DSAEK at MedPark Hospital
Eye Center at MedPark Hospital, Bangkok, Thailand is led by a team of ophthalmologist subspecialists with national and international experience, who are ready to diagnose and treat common ophthalmologic diseases and complex corneal dystrophies with corneal transplants, including full-thickness cornea transplant PKP and partial-thickness cornea transplant (DMEK, DSAEK, and DALK), to restore clarity and vision improve quality of life using state-of-the-art medical technology and equipment and the highest standard of care, aiding in treatment safety, speed up recovery, and maximizing treatment efficiency. Our team provides comprehensive care, including post-treatment follow-up, to ensure optimal outcomes, allowing patients to have a long-lasting healthy eyes.
