The cornea is the clear covering of the front of the eye which bends, or refracts, light rays as they enter the eye. For clear vision to occur, the cornea must have the correct shape and clarity to focus incoming light rays precisely on the retina at the back of the eye. When the cornea becomes cloudy or misshapen from injury, infection or disease, transplantation may be recommended to replace it.
There are several different corneal transplant procedures available to help restore vision in patients with corneal problems. The traditional corneal transplant procedure involves replacing the entire damaged cornea with a healthy one from a human donor, which is usually obtained from an eye bank. However, technological advances have allowed for the development of specialized procedures that replace only the damaged part of the cornea, while leaving the healthy parts intact.
Short for Descemet's stripping and automated endothelial keratoplasty, DSAEK replaces only the innermost layers of cells within the cornea, known as the endothelium. This allows the procedure to be performed through a much smaller incision with shorter recovery times and fewer risks than a traditional corneal transplant.
DSAEK is commonly performed on patients with Fuchs' Dystrophy, an inherited eye disease that causes the cells of the endothelium to deteriorate, resulting in distorted vision and corneal swelling. As this condition progresses, vision will continue to worsen as damaged cells cannot grow back.
During the DSAEK procedure, your surgeon will make an incision in the sclera, the white part of the eye. This incision allows the surgeon to access the cornea and remove the damaged endothelial tissue using a microkeratome blade, the same instrument used during LASIK surgery. The donor tissue is then folded and implanted on the eye and the incision is closed with a single stitch.
After the donor tissue has been placed, it will either unfold on its own or be unfolded by the surgeon. Another stitch will then be used to secure the new cornea in place, while an air bubble is injected to properly position it. This procedure is performed with a topical anesthetic to minimize any potential discomfort. The actual DSAEK procedure only takes about 20 to 30 minutes to perform, although patients should plan on being at the surgical facility for about two hours.
Recovery from DSAEK
After the DSAEK procedure, patients will be moved to a recovery room, where they will be monitored for about an hour before being able to go home. Your doctor will prescribe antibiotic and steroid eye drops to be used for the next few days as the eye heals. You will need to return to your doctor the next day for a follow-up appointment as well.
Most patients notice improvements to their vision within the first two weeks after surgery, with results continuing to develop during the next four to six weeks. This is significantly faster than the traditional corneal transplant procedure, which may take six to 12 months before effective results are achieved. Other existing eye conditions may slow or hinder the improvement of vision after the DSAEK procedure.
Risks of DSAEK
While the DSAEK procedure is considered safe for most patients with cornea damage, there are certain risks involved with any type of surgical procedure, including infection, bleeding and more. Although rare, there is a risk of transplant rejection, which may result in redness, sensitivity to light and blurred vision. If you are experiencing these or any other symptoms after DSAEK, you should contact your doctor to prevent any damage from occurring.