DSEK - A State of Sight #11 with Isaac Porter, MD

Dr. Porter explains DSEK, a selective corneal transplant procedure where only the inner layer of the cornea is replaced. This can improve vision in patients with a cloudy or swollen cornea in cases like Fuchs' Dystrophy and edema following eye surgery.

Welcome to A State of Sight, I’m Isaac Porter from Lowry Porter Ophthalmology, and this is your update in ophthalmology and eye care. We are continuing to bring you the latest information in ophthalmology. Today I want to talk with you about DSEK, which stands for Descemet's Stripping Endothelial Keratoplasty, which is commonly known as a partial thickness corneal transplant or an inner layer corneal transplant.
This is different than transplanting the full thickness of the cornea and it’s a newer procedure that’s only been around for about 10 years. To understand exactly what DSEK, let’s look at the eye model. Remember, the cornea is the clear shield that covers the front of the eye.
Instead of removing the central part and transplanting the full thickness of the cornea when it becomes cloudy or swollen, with DSEK, we can transplant just the inner layers of the cornea if only the inner layer is the problem. This could be the case when people have had multiple operations on the eye, if they had glaucoma surgery, or a complicated surgery that can cause a problem with the function of the cornea.
The inner layer (endothelium) consists of many pumps which help pump water out of the cornea back into the eye to keep the cornea thin and clear. When those pumps fail, it could be necessary to have a transplant, DSEK.
Another reason is a genetic condition, Fuchs dystrophy, that people are born with that gets worse as time goes by. When they become older, this dystrophy may cause swelling in the cornea or problems with this inner layer called guttae that can cause glare or blurred vision.
The advantages of transplanting only the inner layer compared to transplanting the full thickness of the cornea include a quicker recovery and less sutures used in this type of operation. This can be more comfortable for the patient and also will cause less astigmatism. In a full thickness corneal transplant (PKP or penetrating keratoplasty), lots of stitches in the cornea can cause irregularity in the curvature or astigmatism.
For more details about astigmatism, you can refer back to an older episode of A State of Sight where I went into detail about astigmatism.
This procedure, DSEK, usually takes less than 1 hour and patients have to do specific positioning to recover since we put air in the eye to help the transplant to stay in place.
The front part of the eye is filled with air and this helps the transplant attach until it has a chance to heal on it’s own. Therefore, for the first 24 hours, patients have to face straight up toward the ceiling to make the air bubble float up against the inside of the cornea and hold the transplant in place. With time the transplant seals and pumps itself where it sticks naturally.

If you have trouble with your cornea including clouding or swelling, DSEK may be an option for you. If you have any questions about this, please post, and we will be happy to answer. Until we see you again on the next episode of A State of Sight, good health and good sight.