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Corneal Transplant
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Corneal Transplant Surgery – Austin Eye

Cornea Transplant Surgery – DSEK and DMEK

Descemet’s stripping endothelial keratoplasty (aka DSAEK or DSEK):

As we age, various disease states cause the cornea (the front clear window of the eye) to become cloudy. The top three conditions that cause the cornea to become cloudy are: 1) Fuch’s Dystrophy (a genetic condition which causes gradual clouding of the cornea with age), 2) Pseudophakic bullous keratopathy (a cloudy cornea that arises after cataract surgery), and 3) graft failure after previous cornea transplantation. These conditions cause the inner layer of the cornea known as the corneal endothelium to lose its normal function. The cornea endothelium’s primary function is to maintain the clarity, thickness and water content of the cornea.

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Descemet’s stripping endothelial keratoplasty was the preferred treatment for corneal endothelial dysfunction from 2008-2013. Descemet’s Stripping Endothelial Keratoplasty (DSEK) is a posterior corneal transplantation technique that replaces dysfonctional recipient endothelium with healthy donor tissue while sparing the entire recipient stroma. DSEK is currently recognized as the “state-of-the-art” in the endothelial keratoplasty field. DSEK produces excellent visual outcomes with minimal change in corneal surface topography or refraction. It can successfully treat corneal dysfunction associated with Fuchs’ endothelial dystrophy, bullous keratopathy, iridocorneal endothelial syndrome or a failed cornea transplant. Donor dissection has become automated, and new techniques have been devised to facilitate graft insertion and unfolding. We now routinely perform DSEK with topical anesthesia. Graft detachment is the most frequent early postoperative complication, but new methods can help promote donor adherence. The incidence of graft-rejection episodes is lower after DSEK compared with standard penetrating keratoplasty, possibly because wound healing is a lesser concern.

We have been doing DSAEK and DSEK since early 2008. The results have proven themselves to be much better than the results of full-thickness cornea transplantation. There is recovery of functional vision within weeks (rather than 6-12 months with full-thickness cornea transplantation), the procedure is safer and less invasive than regular cornea transplantation.

Advantages of DSEK (over full thickness Corneal transplantation aka Penetrating Keratoplasty/PKP):

  • Stronger wound, resistant to trauma.
  • Corneal nerves preserved.
  • Faster recovery of vision compared to full-thickness cornea transplantion.
  • No suture related complications.

DMEK or Descemet’s Membrane Endothelial keratoplasty represents the most advanced form of lamellar keratoplasty for treatment of Fuch’s dystrophy, Pseudophakic bullous keratopathy and corneal clouding from corneal endothelial dysfuntion. Austin Eye began is proud to be one of the few centers in Texas to offer DMEK for our patients.

Advantages of DMEK (over DSEK):

  • Lowest rejection rate, smallest incision, best visual potential of any corneal transplant surgery
  • Less induction of refractive errors/hyperopic shift

About Austin Eye

For those seeking an experienced eye doctor Austin residents trust, Austin Eye features a team of highly qualified Austin eye care providers dedicated to providing patients with a top-quality vision correction experience. The surgeons at Austin Eye have many years of experience and training in a variety of eye surgery procedures.

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Postop DSAEK (Source Mark Gorovoy, MD)
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Inserting folded donor tissue with DSAEK (Source Mark Gorovoy, MD)