A special type of corneal transplantation is a partial transplant of just the back portion of the cornea called DSEK (Descemet's Stripping Endothelial Keratoplasty). The cornea has five layers and the deepest layer is delicate and can be damaged in diseases such as Fuchs dystrophy, Pseudophakic bullous keratopathy (PBK), Aphakic bullous keratopathy (ABK), and Posterior Polymorphous dystrophy (PPMD). In DSEK, the thin endothelial layer is removed and replaced with a similar layer from a donor cornea.
This is an excellent alternative to a full thickness transplant in certain patients that have a healthy cornea except the back layer. There is faster visual recovery, less astigmatism, and minimal stitches needed than a full thickness transplant. In addition this surgery can be combined with cataract surgery. Like any corneal transplant procedure there is still some risk of infection or rejection of the new donor tissue, so taking your medications properly and careful follow-up examinations are important.
The DSEK Procedure:
- The patient’s endothelial layer is removed from the rest of the cornea.
- The donor endothelium attached to a thin layer of donor cornea is folded and inserted through a small incision.
- An air bubble is injected to push the donor cornea up against the posterior surface of the patient’s cornea.
- The pumping action of the new donor endothelium helps bond the donor tissue to the patient’s own cornea.