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Endothelial Keratoplasty (DSEK & DMEK)

Endothelial keratoplasty (EK) is a specialized corneal transplant technique designed to restore vision when the inner cell layer of the cornea, known as the endothelium, ceases to function properly. This procedure is particularly effective for conditions like Fuchs’ dystrophy, bullous keratopathy, iridocorneal endothelial (ICE) syndrome, and other endothelial disorders. EK replaces only the diseased layer of the cornea, preserving the healthy corneal tissue.

Types of Endothelial Keratoplasty

Descemet’s Stripping Endothelial Keratoplasty (DSEK): Introduced in 2003, DSEK involves replacing the back 20-30% of the donor cornea. It is the most common type of EK, offering a quicker visual recovery and fewer restrictions on activities compared to traditional full-thickness transplants. Patients typically achieve an average vision of 20/30 or better within a few months, and the rejection risk is around 12%.

Descemet’s Membrane Endothelial Keratoplasty (DMEK): A more recent innovation, DMEK uses extremely thin donor tissue, just 5% of the corneal thickness, and has been available since 2008. DMEK provides superior visual outcomes, with about 75% of patients achieving 20/25 vision or better. The rejection risk with DMEK is less than 1%.

The EK Procedure

Surgical Steps:

Removal of Diseased Tissue: The surgeon removes the diseased inner cell layer of the cornea.
Implantation of Donor Tissue: Healthy donor tissue is implanted through a small incision.
Positioning with Air Bubble: An air bubble is used to unfold and position the donor tissue against the patient’s cornea.

The incision is typically self-sealing or may require a few sutures. The procedure is often performed using eye drops to numb the eye, providing a comfortable and efficient surgical experience.

Advantages of Endothelial Keratoplasty

Compared to traditional full-thickness transplants, EK offers several benefits:

Stronger Eye Post-Surgery: The eye remains more resilient and less prone to injury.
Faster Visual Recovery: Patients experience quicker improvement in vision.
Minimal Activity Restrictions: Post-surgery, patients have fewer limitations on their activities.
Stable Glasses Prescription: There is minimal change needed in glasses prescription after surgery.

Specifics of DSEK and DMEK

DSEK (Descemet’s Stripping Endothelial Keratoplasty):

Procedure: Involves implanting the back 20-30% of the donor cornea.
Recovery: Patients usually achieve 20/30 vision or better within a few months.
Rejection Risk: Approximately 12%.

DMEK (Descemet’s Membrane Endothelial Keratoplasty):

Procedure: Uses ultra-thin donor tissue (5% of corneal thickness).
Recovery: Provides 20/25 vision or better for about 75% of patients.
Rejection Risk: Less than 1%.

Challenges with DMEK:

Donor Tissue Preparation: The thin grafts are fragile, requiring meticulous preparation to avoid damage.

Surgical Technique: The graft often curls into a scroll and must be carefully unrolled and positioned.

Post-Operative Care

Immediate Post-Surgery:

Monitoring: Patients are monitored for about two hours after surgery before being discharged.

Follow-Up Appointments: Patients return for check-ups the day after surgery, the following day, and typically on the fifth day post-surgery.

Ongoing Care:

Eye Drops: Use as prescribed to prevent infection and promote healing.

Activity Restrictions: Follow specific guidelines from your surgeon to ensure proper healing.

Contact Us

For more detailed information about endothelial keratoplasty and to discuss your specific condition, please contact the specialists at Mid Florida Eye Center. We are dedicated to providing advanced surgical solutions and comprehensive care to restore your vision.