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DSAEK: The Sutureless Corneal Transplant at North Shore-LIJ

DSAEK: The Sutureless Corneal Transplant

DSAEK (Descemet’s stripping automated endothelial keratoplasty) is a new option for some patients who need corneal transplants. There are numerous advantages over traditional corneal transplant surgery which include:

  • Quicker visual recovery
  • Less astigmatism created since there are no sutures
  • The eye tissue maintains more strength since only the diseased tissue rather than the entire cornea
  • Procedure time is quicker
  • Reduced risk of rejection
  • Surgery can be combined with cataract surgery

The back layer of the cornea, called the endothelium, is responsible for keeping the cornea clear by using special pumps to remove any excess fluids. Unlike skin cells, once the cornea cells are damaged, they are not able to grow back. Some diseases can reduced the number of endothelial cells leading to swelling (edema) and possible vision loss. In some cases this can be permanent.

Pseudophakic Bullous Keratopathy — Corneal Edema (swelling)

In pseudophakic bullous keratopathy one's cornea has become permanently swollen after cataract surgery. After damage, the fluid that flows within the eyeball seeps into the cornea. This causes it to become swollen and cloudy.

There can be many different causes from cataract surgery in which this condition develops: physical trauma during the procedure, inflammation following the operation, or bleeding. When one is afflicted with pseudophakic bullous keratopathy, the cornea is permanently swollen; no medications, glasses, or contact lenses can help improve one’s vision.

Fuchs' Endothelial Dystrophy

In Fuchs' endothelial dystrophy, the older cells that have thickened (guttata) increase in size and numbers and eventually fluid builds up within the cornea. Patients report blurry or foggy vision in the morning and are prone to seeing halos around lights early in the morning. There is also some difficulty reading during the early part of the day. As the day continues, vision usually increases and images become crisp. Fuchs' endothelial dystrophy progresses, causing the swelling of the cornea to persist longer throughout the day.

DSAEK Procedure:

  1. The patient’s endothelial layer is stripped from the rest of the cornea.
  2. The donor endothelium attached to a thin layer of donor cornea is folded like a taco and inserted through a 5mm incision.
  3. An air bubble is injected to push the donor cornea up against the posterior surface of the patient’s cornea.
  4. The pumping action of the new donor endothelium helps to create suction which bonds the donor tissue to the patient’s own cornea

If you would like more information about DSAEK or would like to make an appointment with one of our cornea specialists, please call our office at (516) 470-2020 to make an appointment.