When the inner most layer of the central cornea stops working properly, the cornea becomes cloudy over time. For the last 40 years, the only procedure to correct this problem was to replace the (entire) full thickness of the cornea with a corneal transplant (PKP). Over the last several years, a revolutionary new procedure has been developed to replace only the innermost critical layer of the cornea. This procedure is known as DSEK or Descemet’s Stripping Endothelial Keratoplasty. This procedure has tremendous advantages over its predecessor, i.e. the full thickness corneal procedure since the cornea heals much faster and stronger and the patient’s visual recovery is much quicker.
Because this technique uses only a single suture, it significantly improves the visual results and it is Dr. Liu’s preferred technique for patients with Fuchs’ dystrophy, bullous keratopathy and even failed full thickness corneal transplants in many cases. In fact, he doesn’t recommend standard penetrating keratoplasty for endothelial dysfunction unless there is significant scarring of the superficial layers of the cornea. DSEK patients oftentimes can see 20/40 or better within the first 3 months of surgery and sometimes even 20/20. Dr. Liu is among the most experienced surgeon in Northern California to offer the DSEK procedure and he performs the surgery locally in his own Ambulatory Surgery Center, Peninsula Eye Surgery Center, in Mountain View, California.
The entire procedure usually takes less than an hour and is performed through a 1/4 inch incision requiring only a single suture in most cases. An air bubble is used to hold the donor tissue up against the posterior surface of the patient’s own cornea. The natural pumping action of the donor cornea quickly creates an adherence or “bonding” of the donor cornea to the recipient cornea.
Advantages of DSEK as compared to full thickness transplants (or PKP) are:
- The eye is left much stronger and more resistant to injury
- Minimal change in refractive error due to fewer sutures
- Suture-related problems are negligible with much less astigmatism
- Visual recovery is significantly faster
In summary, DSEK offers patients much better and quicker visual recovery and a less protracted clinical course than standard PKP. It is a great alternative for almost all patients with only posterior corneal conditions such as Fuch’s dystrophy.