From the Guidelines
DSEK, or Descemet's Stripping Endothelial Keratoplasty, is a partial-thickness corneal transplant procedure that involves the removal of the diseased endothelial cell layer and Descemet's membrane from the patient's cornea and replacement with healthy donor tissue, as described in the most recent study 1.
Overview of DSEK
This procedure is used to treat conditions affecting the innermost layer of the cornea, such as Fuchs' dystrophy or bullous keratopathy. The key steps in DSEK include:
- Removal of the recipient Descemet's membrane
- Replacement with a thin donor lenticule that includes posterior stroma and Descemet's membrane
- The DSEK donor tissue is usually manually prepared by the surgeon
Advantages of DSEK
The advantages of DSEK over full-thickness corneal transplants include:
- Faster visual recovery, typically weeks to months rather than a year
- Stronger wound integrity
- Less induced astigmatism
- Reduced risk of rejection, as noted in the study 1
Postoperative Care
Patients typically require topical steroids postoperatively for several months to prevent graft rejection, with a gradual tapering schedule determined by their surgeon. The study 1 highlights the importance of proper postoperative care to minimize complications and ensure optimal outcomes.
Comparison with Other Procedures
DSEK has become a standard treatment for endothelial dysfunction due to its superior outcomes and faster recovery, as compared to other procedures like penetrating keratoplasty (PK), according to the study 1. The broad acceptance of EK is due to the rapid visual recovery, significantly greater optical predictability, smaller and more stable wounds, and decreased risk of graft rejection compared with PK.
From the Research
Definition and Purpose of DSEK
- Descemet's Stripping Endothelial Keratoplasty (DSEK) is a surgical procedure used to treat endothelial dysfunctions, such as pseudophakic corneal edema and bullous keratopathy, Fuchs' dystrophy, and iridocorneal endothelial syndrome 2, 3, 4.
- The procedure involves the selective replacement of the dysfunctional endothelium with a healthy donor endothelium and posterior stroma, which is then attached to the recipient cornea without sutures 2, 5, 4.
Surgical Technique and Outcomes
- The DSEK procedure typically involves stripping the Descemet membrane and endothelium from the recipient cornea, followed by the implantation of a donor button consisting of posterior stroma and healthy endothelium 2, 5, 4.
- The donor tissue is folded and inserted through a small incision, and an air bubble is used to press the donor tissue against the recipient cornea, allowing it to attach without sutures 2, 5, 4.
- Studies have shown that DSEK can provide significant improvements in visual acuity, with many patients achieving a best-corrected visual acuity of 20/40 or better 2, 3, 5.
- The procedure has also been shown to be safe and effective, with low rates of complications such as graft failure and dislocation 2, 3, 5.
Comparison with Other Procedures
- DSEK has been compared to other endothelial keratoplasty procedures, such as Descemet membrane endothelial keratoplasty (DMEK), which involves the transplantation of an isolated donor Descemet membrane carrying its endothelium 3, 6.
- Studies have shown that DMEK can provide better visual outcomes and lower rates of immunologic rejection compared to DSEK 3, 6.
- However, DSEK remains a popular and effective treatment option for endothelial dysfunctions, and can be safely combined with other procedures such as manual small-incision cataract surgery (MSICS) with posterior chamber intraocular lens (PCIOL) 2.