Endothelial Keratoplasty Surgery

A partial-thickness corneal transplant

 

Endothelial Keratoplasty (DSAEK & DMEK) Surgery

Endothelial Keratoplasty (EK) is a cornea transplant technique that can restore lost vision when the endothelium, the innermost layer of cells of the cornea, are no longer functioning adequately.

There are a two variants of EK surgery:

  • Descemets’ Stripping Automated Endothelial Keratoplasty (DSAEK)

  • Descemets’ Membrane Endothelial Keratosplaty (DMEK)

Medical conditions including Fuchs’ dystrophy, bullous keratopathy, iridocorneal endothelial (ICE) syndrome, or other endothelial disorders may cause blurry or cloudy vision and glare. Vision is typically worse in the morning and clears up throughout the day. An EK procedure selectively replaces only the diseased layer of the cornea, leaving healthy areas intact.

There are many advantages of an EK surgery over a full-thickness Penetrating Keratoplasty surgery, including:

  • faster recovery time

  • lower risk, and less invasive surgery

  • fewer sutures in the eye, and a lower chance of an infection

  • better long-term quality of vision

  • lower long-term risk of graft rejection

What is the difference between a DSAEK surgery and DMEK surgery?

A Descemets’ membrane endothelial keratoplasty (DMEK) is very similar to DSAEK, except that the implanted donor tissue does not include any stromal tissue. A DMEK is an exciting option to treat decreased vision and swollen cloud corneas and it is a pure replacement of endothelium. DMEK is the most anatomical repair of the three generations of corneal transplantation with just one cell layer and a thin membrane, all of which are only 15 to 20 microns thick.

DMEK Procedure

  • 15-20 microns of endothelial cell layer and Descemets’ membrane transplanted into the eye

  • Minimal disruption of ocular anatomy

  • lowest lifetime risk of graft rejection

  • Patients have a very high quality of vision afterwards, many achieving vision of 20/25 or better

DSAEK Procedure

  • 60-120 microns of corneal stroma, along with endothelial cell layer and Descemets’ membrane transplanted into the eye

  • Can be performed in patients with complex ocular anatomy (prior corneal transplant, history of glaucoma, prior trauma)

  • Easier post-operative recovery experience

  • Patients have a very good quality of vision afterwards, many achieving vision of 20/30 or better

What To Expect During a DSAEK or a DMEK Procedure

During both DSAEK and DMEK surgery, the diseased innermost layer of the cornea is removed and the thin layer from a healthy donor cornea is put in its place. The transplant is then held in place by only an air bubble. Patients will be required to lay flat on their backs with their faces directed upwards immediately after surgery to float the bubble into place. For patients who have had DSAEK, the patient will have to lay flat on their back for 24-36 hours after surgery while the air bubble dissipates. For patients who have had DMEK surgery, the air bubble is mixed with SF6 gas, and the patient will have to lay flat on their back for 4-5 days after surgery.

Your doctor will discuss with you the options that will better suit your needs.

 

DMEK vs DSEK surgery

What is the advantage of DMEK surgery (compared to DSEK surgery)?

DMEK has been shown to offer patients the best chance to see 20/25 and resume their daily activities quickly. There is also a slightly lower long-term risk of graft rejection with DMEK compared to DSEK.

What is the disadvantage of DMEK surgery (compared to DSEK surgery)?

A patient has to lay flat for a longer time after DMEK surgery, compared to DSEK surgery, because the thinner graft does not stick/adhere to the host cornea quite as well. A longer period of time is needed to ensure that the graft adheres well. The chance of a graft detachment is also much higher.

Your doctor will discuss with you the options that will better suit your needs.

When is DSEK preferred over DMEK?

Usually DSEK is preferred over DMEK surgery when a patient cannot lay flat long enough for DMEK, or has issues laying flat in general. Patients with neck, spine issues or back pain in general may benefit from DSEK surgery. Complicated EK surgery generally favors DSEK. Patients with other ocular conditions (a history of a prior corneal transplant, prior eye surgery/trauma, a history of glaucoma) typically benefit more from DSEK surgery

An eye exam is the best way to screen for, and evaluate any eye conditions affecting your health, comfort, and quality of vision.