DSAEK is the latest technique in corneal transplantation which Dr. Jeffrey Maehara is proud to offer in his Honolulu, HI office. Short for Descemet-Stripping Automated Endothelial Keratoplasty, DSAEK offers clear post-operative vision and short recovery time to patients in need of new corneas.
The cornea is the clear covering of the front of the eye that focuses incoming light. For you to see accurately, your cornea needs to be clear and of the correct shape. When the cornea becomes cloudy or misshapen, a cornea transplant may be necessary to restore vision or repair the integrity of the eye.
Formerly the entire cornea had to be replaced with healthy donor tissue. But thanks to relatively recent advances, individual layers of the cornea can now be replaced, making for far shorter recovery periods and better outcomes. Dr. Maehara performs Descemet’s stripping automated endothelial keratoplasty (DSAEK) to replace the inner layer of the cornea.
What is the Endothelium?
The cornea is about 1/10th of a centimeter thick and is made up of three layers: the epithelium, a thin surface layer; the stroma, a middle layer composed of mostly fibrous proteins that absorb fluid from inside the eye; and the endothelium, a single layer of cells coating the inside portion of the cornea. The job of the endothelium is to provide nutrients to the cells in the stroma and to make sure the stroma has the correct amount of fluid. Too much fluid in the stroma can cause swelling of the cornea and decreased vision.
What Happens in Endothelial Failure?
The cells on the cornea’s inner endothelium layer are very fragile. They can be easily damaged, and once an endothelial cell dies it will not grow back. Two of the most common causes of endothelial failure are a disease known as Fuchs’Dystrophy and trauma following cataract or glaucoma surgery. If too many of the endothelial cells are damaged or die, the layer can’t maintain proper corneal thickness or clarity. Too much fluid builds in the stroma, causing swelling and decreased vision.
What Are The Advantages Of Using DSAEK Rather Than Full Cornea Replacement?
This endothelial replacement, rather than the entire cornea, has a number of benefits for the patient:
- The eye surface is kept intact because only the diseased back layer of the patient’s cornea is removed. This keeps the cornea stronger and more resistant to injury and infection.
- There is minimal change in refraction and visual acuity because only the endothelial layer is replaced, rather than the entire cornea.
- Problems with sutures are significantly reduced or eliminated.
- Visual recovery is significantly faster and more dependable.
- Fewer risk factors are involved.
In contrast to DSAEK surgery, a conventional corneal transplant requires 16 sutures and a prolonged recovery time. Plus, many patients report a significant post-operative astigmatism after their transplant surgery. Full recovery can take from one to two years.
Patients are given topical anesthesia so they can’t feel anything during the DSAEK procedure. First, the surgeon cuts and prepares the donor cornea. Next, he or she makes a mark in the surface of the patient’s cornea with a trephine (an instrument used to cut circular sections of tissue). That mark serves two purposes: it helps the surgeon determine what size the transplant should be, and it outlines the area of the patient’s cornea that needs to be peeled away.
Next, the surgeon scores the damaged section of the cornea and strips the membrane away from the eye using a microkeratome blade – the same instrument used in LASIK surgery. Then the donor cornea is folded into a “taco” shape and placed on the eye. A single stitch closes the incision.
Sometimes the new cornea unfolds on its own; other times, the surgeon unfolds it him/herself. When it is unfolded, a second stitch is made to close the wound and anchor the new cornea in place. The surgeon then injects an air bubble underneath the cornea, making sure it is centered on the eye, and dilates the pupil with eye drops.
Patients are sent to the recovery room for about one hour, after which they are examined at the slit lamp with the doctor. He or she gently presses on the cornea until most of the air bubble is released. Patients are then given antibiotics and steroid eye drops and will return the next day for a follow-up appointment. About 10% of patients need a second bubble injection to re-center the cornea.
Is DSAEK Surgery Painful, And What Follows My Surgery?
No, patients are anesthetized prior to the procedure, so they don’t feel a thing. There can be a sensation of pressure around the eye, but there is no pain. After your surgery, you will have a patch over your eye. You are instructed to rest for the remainder of the day, lying flat on your back. This keeps the air bubble against the corneal transplant.
Will I Have Sutures With DSAEK?
The procedure requires only a tiny incision that can be closed with a single suture. Often even that suture is not required for healing.
Will I Need Eye Drops?
Yes. Eye drops are used as anti-rejection medication and are required for a number of years.
Other Recovery Items
You’ll need to refrain from bending below the waist for three weeks after your surgery. There cannot be any heavy lifting for three weeks, as well. For the first few days following your DSAEK surgery, you’ll feel scratchiness in the eye from your incision. This should pass within a week. Your vision will be blurry after surgery due to swelling and the air bubble used to keep the transplant in place. The air bubble is absorbed within the first week, but swelling may last for a couple months.
Will My Vision Change After DSAEK Surgery?
Immediately afterwards your vision will be blurry due to swelling and the air bubble. As the bubble dissolves and initial swelling decreases, your vision will improve. You may need new glasses while your eye is healing, as the best vision will generally take up to three months to show itself.
When Will I Be Able To Drive After DSAEK Surgery?
Some patients may achieve driving-quality vision in as little as one week, but driving should be cleared with Dr. Maehara during one of your subsequent visits.
When Can I Return To Work?
Most DSAEK patients can return to work within a few days after this surgery. Of course, if your job involves heavy lifting and such, those activities will have to wait for three weeks, as mentioned above.