Descemet’s Stripping Endothelial Keratoplasty (DSEK) for Corneal Endothelial Disorders

In this blog, we delve into Descemet’s Stripping Endothelial Keratoplasty (DSEK) as a treatment for corneal endothelial disorders. DSEK is a surgical procedure that has gained significant recognition recently due to its remarkable efficacy in addressing various corneal conditions.

Understanding Corneal Endothelial Disorders

Corneal endothelial disorders encompass a range of conditions that affect the endothelial layer of the cornea. This critical layer is responsible for maintaining corneal clarity by regulating fluid levels within the cornea. When the corneal endothelium becomes compromised, it can lead to vision impairment and discomfort.

Cloudy cornea on one side requiring a corneal transplant and stromal transplant on the other - Dr Anthony Maloof, Sydney.

The Emergence of DSEK

Descemet’s Stripping Endothelial Keratoplasty, commonly referred to as DSEK, emerged as a revolutionary solution for corneal endothelial disorders. This procedure involves the transplantation of a thin layer of donor tissue, including the endothelium and Descemet’s membrane, into the patient’s cornea. The primary goal of DSEK is to replace damaged or dysfunctional endothelial cells and restore corneal clarity.

Advantages of DSEK

1. Minimally Invasive

DSEK is a minimally invasive surgical technique that offers several advantages over traditional penetrating keratoplasty (PK). Unlike PK, which involves the replacement of the entire corneal thickness, DSEK only replaces the damaged endothelial layer. This results in faster recovery times and reduced risk of complications.

2. Improved Visual Outcomes

Patients who undergo DSEK often experience rapid improvements in visual acuity. The procedure’s ability to restore corneal clarity translates to better vision and an enhanced quality of life for individuals suffering from corneal endothelial disorders.

3. Reduced Graft Rejection

DSEK’s selective replacement of the endothelial layer minimizes the risk of graft rejection. Since the procedure does not involve extensive corneal tissue transplantation, the recipient’s immune response is less likely to be triggered.

Patient Selection and Evaluation

Before undergoing DSEK, patient selection and evaluation are crucial steps. Not all individuals with corneal endothelial disorders are suitable candidates for this procedure. Factors such as age, overall eye health, and the specific condition must be carefully assessed.

The DSEK Procedure

1. Donor Tissue Preparation

The first step in DSEK involves the preparation of the donor tissue. A small, circular disc of corneal tissue, including the endothelium and Descemet’s membrane, is meticulously dissected from a donor cornea.

Corneal tissue from the NSW Tissue Bank

2. Recipient Cornea Preparation

The recipient’s cornea is then prepared by creating a small incision to allow for the insertion of the donor tissue. This incision is typically less than 4mm in size, minimizing the risk of induced astigmatism.

3. Tissue Insertion

The donor tissue is gently inserted into the recipient’s cornea through the small incision. Once in place, an air bubble is introduced to facilitate adhesion between the donor tissue and the recipient’s cornea.

Air after endothelial transplant by Dr Anthony Maloof
Air after endothelial transplant by Dr Anthony Maloof

4. Recovery and Follow-Up

Following the procedure, patients are closely monitored during the recovery period. Eye drops and medications are prescribed to promote healing and prevent infection. Regular follow-up appointments are essential to track progress and address any concerns.

Outcomes and Success Rates

DSEK has demonstrated impressive success rates in the treatment of corneal endothelial disorders. Many patients experience rapid visual improvement within weeks of the procedure, and the risk of graft rejection is significantly lower compared to traditional keratoplasty techniques.

Descemet’s Stripping Endothelial Keratoplasty (DSEK) stands as a ground-breaking solution for individuals suffering from corneal endothelial disorders. Its minimally invasive nature, swift visual recovery, and reduced graft rejection rates make it a preferred choice among ophthalmologists and patients alike. As research continues to advance in the field of corneal transplantation, DSEK remains a shining beacon of hope for those seeking improved vision and a better quality of life.

With its remarkable success rates and the potential to transform the lives of countless individuals, DSEK unquestionably merits its place at the forefront of ophthalmic innovations.

For more before and afters click here!

We can help

If you suffer from a corneal issue and think we can help, then you can request an appointment online or call the clinic on 1300 393 322. We have 2 Sydney locations for consultation, Westmead and the city on Macquarie Street opposite the Eye Hospital.