Choose the content to read

• Why DSAEK?
• What causes corneal endothelial dysfunction?
• What are the symptoms of corneal endothelial dysfunction?
• What diseases does DSAEK treat?
• What is the DSAEK corneal transplant procedure?
• What is the advantage of DSAEK?
• What is the success rate of DSAEK?
• DSAEK Corneal Transplant at MedPark Hospital

DSAEK Corneal Transplant

DSAEK (Descemet's stripping automated endothelial keratoplasty) is a partial-thickness corneal transplant procedure that involves removing only deteriorated or diseased endothelial corneal layers and replacing them with a partial-thickness donor cornea containing healthy endothelial layer. DSAEK corneal transplant is suitable for individuals with abnormalities in only Descemet’s membrane and endothelium (layers 4-5) but a healthy anterior cornea (layers 1-3). The ophthalmologist will use anterior air bubble pressurization techniques to push the outermost corneal layers against the inner corneas. As the corneal tissue cells gradually merge, the Descemet's membrane and endothelium slowly suck out water from the cloudy cornea, allowing the cornea to become clear, reducing swelling, and restoring clear vision.

Why DSAEK?

In the past, ophthalmologists treated corneal edema from an iridocorneal endothelial syndrome, Fuchs’ endothelial corneal dystrophy, congenital hereditary endothelial dystrophy, or posterior corneal scarring due to infection or injury abnormalities with full-thickness cornea transplant (penetrating keratoplasty: PKP), leaving large slow-healing corneal wounds, requiring many stitches for wound closure, and taking a long recovery period, while affecting vision acuity and have a high rate of infection-related surgical stitches.

DSAEK removes only the posterior cornea layers 4-5 and transplants healthy donor corneas through a 3-4 mm. single side incision, preserving the remaining healthy anterior cornea layers, requiring no wound stitching, shortening recovery time, minimizing impact on eyesight, lowering the risk of infectious complications, and restoring vision acuity quickly.

What causes corneal endothelial dysfunction?

• Aging
• Genetics 
• Eye injury
• Trauma after ocular surgery
• Corneal endothelial disease or abnormalities.
• Corneal scarring from infection or injury.

What are the symptoms of corneal endothelial dysfunction?

• Blurred vision, inability to see things clearly
• Fluctuation in vision, typically worse in the morning and improving toward the end of the day
• Dim-brightness vision or reduced contrast sensitivity
• Light sensitivity
• Glare or have difficulty with nighttime driving
• Eye discomfort, eye pain
• Eye irritation, a foreign body sensation in the eye

What diseases does DSAEK treat?

DSAEK treats the inner corneal layers, including Descemet's membrane and endothelium, that have degenerated due to diseases or abnormalities, as follows:

• Fuchs' Endothelial Corneal Dystrophy
• Iridocorneal Endothelial Syndrome
• Bullous Keratopathy
• Corneal edema due to complications of eye surgery
• Congenital hereditary endothelial dystrophy
• Posterior corneal scarring due to infection or injury 
• Failed graft

What is the diagnosis before DSAEK?

The ophthalmologist will perform the following assessment steps in order to determine the patient's suitability for corneal transplant using the DSAEK technique: obtain a medical history, perform a thorough eye examination with slit lamp biomicroscope, and perform further investigations, including specular microscopy, pachymetry, and anterior segment optical coherence tomography.

What is the DSAEK corneal transplant procedure?

Preoperative DSAEK corneal transplant

• When an ophthalmologist determines the patient is a good candidate for a DSAEK corneal transplant, the hospital immediately places the patient on a waiting list to receive corneal donations from the local eye bank or, in cases of urgency, the hospital may consider purchasing and importing donated corneas from abroad instead.
• Once a donor corneal is confirmed from the eye bank and the corneal is qualified and healthy, the hospital will notify the patient and schedule the surgery date.
• The ophthalmologist may arrange for you to undergo a laser peripheral iridotomy prior to the scheduled surgery date in order to prevent the risk of postoperative intraocular pressure elevation.
• Prior to the surgery date, the hospital will schedule a physical examination, as follows:
  
  • Blood Tests
  • Electrocardiogram (EKG/ECG)
  • Chest X-ray

Intraoperative DSAEK corneal transplant

• The ophthalmologist will perform DSAEK corneal transplant surgery by removing the degenerated or diseased endothelial corneal layers (layers 4-5) via a small eye-side incision similar to a cataract surgical incision and replacing it with a donor cornea. Following the DSAEK keratoplasty, the ophthalmologist will transplant only a thin partial stoma (layer 3) and a full-thickness Descemet's membrane and endothelium (layers 4–5). 
• The new cornea will be firmly adhered to the outer cornea by natural eye (intraocular) pressure combined with the air bubble pressure technique, using an ophthalmoscope to inject air bubbles into the anterior chamber to exert pressure pushing the outer corneas against the inner corneas. The air bubbles will help speed up the wound's healing process without the need for any stitches. The air bubbles will gradually reabsorb in 3–4 days. Typically, DSAEK corneal transplant takes approximately 1 hour, depending on the complexity of each patient and any concurrent operations.

Postoperative DSAEK corneal transplant

• After the surgery is complete, the ophthalmologist will cover the eyes with eye pads and eye shields.
• The ophthalmologists and nurses will closely monitor the symptoms for the first hour after surgery.
• The patients will be required to lie supine for the first hour of recovery. This allows the natural air bubble to float upward and press the graft against the back of the anterior cornea layers, facilitating its adhesion to the posterior cornea layers.
• Patients are allowed to get up to go to the restroom, stretch their legs, and have meals. However, during the initial few days following surgery, the patient is recommended to lie on the back as much as possible to facilitate the adhesion.
• Typically, the patient will experience blurry vision the day after the surgery due to the residual air bubble in the eye which will gradually disappear over the next few days.

What is the post operative care for DSAEK?

• The ophthalmologist will schedule a follow-up appointment the day after the surgery.
• The patient must lie supine for 2–3 days to 1 week after surgery, depending on the remaining volume of air bubble left.
• The ophthalmologist may schedule a re-injection of the air bubble 2-3 days after surgery.
• Cover the eye shield during the day and at night for a minimum of 1 week to prevent the eye from unintentional eye rubbings.
• Consistently administer eye drops on time, per the ophthalmologist's instructions.
• Avoid excessive screen time by scheduling screen-free breaks on electronic devices.
• For 1 week, avoid washing your face, rubbing your eyes, or squeezing your eyes.
• For 1 week, refrain from any activities or exercises that may cause sweat to enter your eyes. 
• Exercise such as treadmill, or walking are permitted in the first post-surgery week.
• Jogging or weightlifting should be avoided for 3 to 4 weeks.
• Attending hospital ophthalmologist appointments to monitor symptoms and evaluate treatment outcomes.

What is the recovery time for DSAEK?

DSAEK corneal transplant requires 2-3 weeks to fully recover and gradually improve noticeable clear vision within 3 months, depending on the individual's physical condition based on patient-factor variables, such as disease severities, and the duration of postoperative corneal edema. These differ from traditional corneal transplants, which may take months or even years for maximum restoration of the vision.

What is the advantage of DSAEK?

• Tiny incision: DSAEK corneal transplant creates a very small surgical wound on the side of the eye, only 3-4 millimeters, which accelerates wound healing and recovery.
• No corneal-graft sutures: DSAEK is a stitch-free surgical technique. After the surgery, the corneal graft is adhered to the front layers of the cornea by intraocular pressure and air bubble pressure from an ophthalmoscope, which reduces suture-related complications, infections, or postoperative astigmatism.
• Fast vision recovery: DSAEK employs a minimally invasive surgery (MIS) technique that helps preserve healthy anterior cornea layers, speed up wound recovery, reduces the risk of corneal astigmatism, and restores clear vision as little as 3 months post-surgery.  
• Low graft rejection risk: DSAEK uses the posterior corneal layer transplantation technique, which eliminates the need to remove and graft all corneal layers, uses less donated corneal tissue, and eliminates the need to stitch the transplanted cornea to the native cornea, lowering the risk of graft rejection.
• Low Complications: DSAEK is a flapless surgical technique that eliminates the need to open the corneal flap, reducing severe infection complications, and suprachoroidal hemorrhage, and significantly reducing the likelihood of flap migration.
• Preserve the strength of the cornea: DSAEK leaves healthy anterior cornea layers unperturbed, minimizes the impact on the cornea, and preserves the cornea strength and natural curvature to the greatest extent possible.
• Immediate disease treatment: DSAEK surgical procedures promptly remove corneal diseases. The newly transplanted cornea will gradually suck water out of the cloudy cornea, allowing the entire cornea to become transparent and restoring vision.
• Accelerate clear vision: Compared to other corneal transplants, which take months or years to produce clear vision, the DSAEK surgical technique shortens the recovery time, accelerating the restoration of clear vision within 3 months.

What is the disadvantage of DSAEK?

• Graft rejection: DSAEK endothelial keratoplasty is a type of corneal transplant in which the body can reject the transplant. Therefore, the patient must administer the prescribed eye drops regularly and return to the ophthalmologist at each appointment to monitor symptoms closely. In cases where the ophthalmologist detects signs of graft rejection, they will treat preemptively to head off the rejection of the corneal transplant.
• Astigmatism or anisometropia: Corneal keratoplasty can result in astigmatism or anisometropia. DSAEK corneal transplant significantly reduces the chances of this happening. However, if astigmatism or anisometropia occurs, the ophthalmologist will treat it by repositioning the transplanted cornea and re-injecting air bubbles to ensure the cornea transplant fits snugly in the correct position.
• Infection: As with any other type of surgery, corneal endothelial keratoplasty can develop infection. However, DSAEK keratoplasty requires tiny incisions and a flapless surgical technique, which reduces the likelihood of this occurrence to less than 1 in 1000 cases.

What is the success rate of DSAEK?

According to the multicenter study's findings, the overall graft success rate for patients undergoing DSAEK corneal transplant surgery at three years is 94%. The patients can achieve corrected distance visual acuity of 20/30 at three months and 20/25 at six months following surgery. This indicates that DSAEK provides a superior visual outcome compared to traditional full-thickness corneal transplants.

What health benefits does DSAEK corneal transplant provide?

DSAEK corneal transplant preserves a healthy anterior corneal layer, shortens recovery time, lowers the risk of graft rejection, reduces suture-related complications, promotes corneal integrity, smoothens the corneal surface, enables quick vision restoration, enhances vision acuity, improves brightness of vision, corrects distorted vision, and improves quality of life.

DSAEK Corneal Transplant at MedPark Hospital

Eye Center at MedPark Hospital, Bangkok, Thailand is led by a team of ophthalmologist subspecialists with national and international experience, who are ready to diagnose and treat common ophthalmologic diseases and complex corneal dystrophies with corneal transplants, including full-thickness cornea transplant: PRP, and partial-thickness cornea transplant: DMEK, DSAEK, and DALK to restore vision acuity and improve quality of life using state-of-the-art medical technology and equipment and the highest standard of care, aiding in treatment safety, speed up recovery, and maximizing treatment efficiency, while also providing post-treatment follow-up to prevent complications, accelerate vision recovery, and allow patients to have a long-lasting healthy eyes.