Recovery after DSEK & DMEK / Endothelial keratoplasty - A State of Sight #113

DSEK and DMEK are the two primary types of inner layer corneal transplantation (endothelial keratoplasty) used today. Watch this episode of A State of Sight with Isaac Porter, MD to learn more about the recovery process following surgery with these techniques.

Welcome to A State of Sight, I’m Isaac Porter. This is your update in ophthalmology and eye care from Raleigh. Today, I would like to explain the recovery after inner layer corneal transplantation (endothelial keratoplasty / EK). The two most common EK techniques are DSEK, Descemet’s Stripping Endothelial Keratoplasty, and DMEK, Descemet’s Membrane Endothelial Keratoplasty.

The recovery is little bit different between the procedures, but there are a lot of similarities so we will cover both. One of the most important things after surgery is the positioning of the patient. After the procedure, the patient lays flat on their back in the recovery room for one hour.

At the end of the operation, we leave an air or gas bubble inside the anterior chamber (the small area between the cornea and the iris in the front of the eye). This air bubble pushes against the graft in order to help it hold in place. Over time, the graft pumps itself into place, but until it has a chance to do this, the air bubble helps support the transplant.

When I perform DSEK, I also put a suture through the bottom part of the graft. This suture helps hold the transplant in place along with the air, but the graft itself is really what helps fixes it permanently. For the first 24 hours, we ask the patient to lay flat or have their nose pointing straight to the ceiling so that the air bubble floats up. When the eye is pointing upwards, the bubble touches the back of the graft. Surgical patients can take a quick break from positioning for the restroom or to eat, but the more they can look up, the better chance the graft has to attach.

When we look on the first postoperative day, we hope that the donor cornea is 100% attached. If it is not completely attached, we may need to put in another bubble, or we may need our patient to position again with the air bubble that’s still in the eye if there is enough remaining. The risk of re-bubbling is greater with DMEK than it is with DSEK. In the end, hopefully we will have full attachment.

On the first day, vision may be cloudy, but we aren’t too concerned about that as long as the graft is attached. Afterwards, there may be sutures that need to be removed, and this can usually be done over the first month.

Patients will also have to use drops during their recovery, including steroid drops and antibiotic drops. The steroid drops may need to be continued for an extended period of time to decrease the chance of graft rejection.

The best vision comes with DSEK about three months after eye surgery when our patients can get a new lens in their glasses. With DMEK, this can occur sooner, around one month postop. If you look back to A State of Sight #26, there is more comparison between the two procedures.

If you have any questions please post them, we will be happy to answer. Hopefully see you again soon next time on A State of Sight!