DSEK is a corneal surgery procedure for severe cases of corneal disease or for damaged corneas. If you are not familiar with the cornea, it is a remarkable structure that helps to focus light and protect the internal structures of the eye. The shape of the cornea is important to the focusing of light on the retina in the back of the eye. A properly shaped cornea and healthy lens will allow this light to focus clearly, providing crisp vision. It is also important that the cornea remain clear so the light can pass through to the retina without being interrupted. If the cornea gets hazy or cloudy, or if the shape of the cornea becomes irregular, vision can be impaired. Some causes of this include age, trauma or disease. When vision is impaired enough to affect a patient’s daily functioning, it may need to be totally or partially replaced by a corneal transplant procedure. Although DSEK is a relatively new, but a well tested corneal surgery technique, it can help some patients who previously required a full thickness corneal transplant.
The procedure is similar to the traditional cornea transplant because both use donor corneas to replace damaged or diseased corneas. Both the conventional corneal transplant technique and DSEK require use of a donor cornea, but DSEK replaces only the damaged posterior section of your cornea. This procedure, which requires minimal suturing, allows for more rapid visual restoration, less discomfort, and a reduced risk of sight-threatening complications.
In DSEK the endothelium is the critical part of the cornea that will be replaced due to damage or disease. It is important to understand a little bit about this part of the cornea before learning what is done in DSEK surgery. The endothelium is the extremely thin, innermost layer of the cornea, and healthy endothelial cells are required to keep the cornea clear. Fluid will drain from the inside of the eye into the middle of the cornea, and the endothelium's primary task is to pump excess fluid back out. Without this pumping action, the stroma would swell with water, become initially hazy and then ultimately opaque.
Fuchs’ Dystrophy patients are the primary group of patients needing a DSEK procedure. Fuchs’ Endothelial Dystrophy (FED) is a degenerative disorder of the corneal endothelium and leads to corneal edema and loss of vision. Patients first receive a full evaluation and testing at Vance Thompson Vision, so our doctors can best determine the patient’s treatment options, including the need for DSEK surgery. One week prior to surgery, the staff at our Sioux Falls ophthalmology practice will begin the process of procuring donor corneal tissue in preparation for the patient’s DSEK surgery and will schedule all appropriate operating room time at the surgical center.
On the day of surgery, the patient will arrive at the surgery center approximately one hour prior to surgery for preparation. The patient must not eat anything after midnight the day before surgery and will begin pre-operative medications three days prior to surgery as instructed. Prior to the patient’s surgery the surgeon will prepare for surgery by determining the type of tissue to be used and selecting the technique needed to ensure the best surgical outcomes possible. After the approximately one-hour surgery, the patient must lie flat on his or her back, so the air can push up into the cornea and hold the new tissue in position. Once the tissue sticks to the cornea, it will begin to function and pump the water out of the cornea, clearing vision. Vision improves fairly rapidly, and final visul results can be expected within 1 and 6 months after surgery.