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What is DSAEK?

DSAEK is an exciting new way to perform corneal transplants (click here for additional background material). DSAEK stands for Descemet’s Stripping Automated Endothelial Keratoplasty. This procedure works for patients whose corneas begin to cloud over due to endothelial dysfunction ( this surgery cannot be performed on a scarred cornea or an irregularly shaped cornea).The endothelium is a layer of pump cells on the back surface of the cornea inside the eye. These cells pump

The endothelium is a layer of pump cells on the back surface of the cornea inside the eye. These cells pump fluid from the cornea to keep the tissue compact and clear. If the pump cells are not working the cornea swells and become cloudy. The most common cause for endothelial dysfunction is an inherited disease called FUCHS dystrophy. In DSAEK, instead of transplanting the full thickness cornea, only these diseased pump cells are replaced.

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The Procedure

DSAEK uses the innovative instrumentation designed for LASIK. In this procedure, the unhealthy pump cells are stripped off the back of the patient’s cornea. The donor tissue is then prepared using the LASIK instrumentation to create only a thin layer of tissue to transplant. This thin layer contains a new healthy layer of pump cells. The benefit of DSAEK is that the thin layer of tissue can be inserted through a very small incision similar to cataract surgery. The tissue adheres to the recipient cornea through the active pump mechanism and does not require any sutures.

Because DSAEK requires less manipulation, the healing time is much quicker, there is less postoperative discomfort, and there is a limited change in the refractive error of the eye.

DSAEK is performed as an outpatient procedure under local anesthesia. The surgery takes about 30 minutes. After the surgery, patients need to lie flat for one hour, to ensure that the tissue adheres properly. The tissue position is examined prior to discharge from the hospital. There is a 10% chance that the tissue will need to be repositioned in the first week after surgery. In the rare circumstance that DSAEK does not work, patients can still subsequently undergo regular corneal transplantation. At Manchester Ophthalmology, we have performed many DSAEK transplants with excellent results.

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