Descemet’s Stripping Automated Endothelial Keratoplasty – DSAEK
This minimally invasive procedure has revolutionised corneal grafting for conditions such as:
- Fuchs Endothelial Dystrophy
- Pseudophakic Bullous Keratopathy
Unlike a traditional full thickness graft where a cornea is completely removed and a new one stitched in, this procedure involves only replacing the innermost layer of the cornea through a small (4mm) incision.
This is a more recently developed procedure (known as DSEK or DSAEK)) that involves only replacing the innermost layers of the cornea rather than the whole cornea as in a Penetrating Keratoplasty or Full Thickness graft. In conditions such as Fuchs endothelial Dystrophy, the innermost layer, the endothelium is diseased. The rest of the cornea is normal. Previously to replace the valuable endothelial layer the whole central cornea was removed and replaced with a donor cornea. This technique of a full thickness corneal graft was also known as a Penetrating Keratoplasty. Surgeons at Centre for Sight have developed instruments for this technique which are used all over the world.
The procedure involves peeling off the inner two layers of the diseased cornea. A donor cornea is then split with a sophisticated automated device creating a thin segment of the inner two layers and a small portion of stroma the mains substance of the cornea. This ultrathin 3 layer donor is inserted into the eye using instrumentation developed by surgeons at Centre for Sight. The graft inside the eye is centred and using an air bubble floated up to stick onto the inside of the cornea replacing the diseased layers removed earlier.
The procedure is technically challenging, however can be accomplished very quickly often with no stitches at all!
The procedure is now the Gold Standard and performed routinely at Centre for Sight and simple but effective instrumentation has been developed by our surgeons to make the process easier.
- Closed eye surgery
- Rapid surgery
- Rapid visual recovery
- Easily replaceable
- Technically challenging
- Grafts can dislocate early requiring further minor intervention
- Interface haze can compromise visual clarity
Authored by Sheraz Daya MD FACP FACS FRCS(Ed) FRCOphth, Consultant Ophthalmic Surgeon & Medical Director, June 2019.
Next review due June 2020.