Corneal Endothelial Transplant (DSAEK)


DSAEK is available at the following centres:

BMI Mount Alvernia Hospital
Manchester Royal Eye Hospital


What does DSAEK stand for?

DSAEK stands for Descemets Stripping Automated Endothelial Keratoplasty.

What is DSAEK?

This is a type of corneal transplant, commonly referred to as a ‘partial thickness’ or ‘lamellar’ corneal transplant. In Fuch’s Endothelial Dystrophy, the inner lining of the cornea, the endothelium, fails to function adequately. With a DSAEK operation, the inner lining is replaced, leaving the outer layers of the cornea untouched. The distinct advantage for this type of surgery is faster recovery, minimal or no stitches and less risk of rejection.


Surgery FAQs

What actually takes place during the operation?
Corneal endothelial graft surgery can be performed under local or general anaesthetic. The inner, unhealthy membrane of your cornea is carefully removed (“Descemet’s stripping”) and replaced with a thin disc of donor cornea, that has been prepared with a very precise instrument called a microkeratome (“automated”).

Our results show a consistently thin graft which means the visual quality is better. The image below is a close up of the interface of a graft.

 

How long does the operation take?

Typically about 30-45 minutes. At the end of the operation the front of the eye is left filled with air to float the corneal graft into place, and you will be kept lying flat on your back for approximately one hour after the operation. This is to allow the graft to attach properly.  During this time it is fine to chat to a relative/friend. Some patients bring headphones to listen to music/radio etc. The eye may ache a little.

After one hour, you may sit up and the doctor will check the eye with a microscope. It is important to stay lying on your back as much as possible. Most patient will be able to go home but occasionally we keep patients for one night in hospital. For the first night, try to sleep on your back as much as possible as well, again to allow the graft to attach properly. The eye will be covered with a clear plastic shield to stop you rubbing it in your sleep.

 

After the operation
You may remove the eye shield the next morning but try not to rub the eye. You can resume all gentle daily activities. Your eye will feel a little irritable and gritty and much more blurred in the first few days. The air bubble can be seen as a dark shape floating about in the lower vision in the first days. If you are working we advise two weeks off work. Severe pain should not occur – if it does you should contact the eye department.

 

Will I need drops after the operation?
Yes. Initially an antibiotic drop four times a day for about four weeks, and a steroid drop four times a day also. Steroid eye drops are very important to prevent rejection of the graft and continue for a year or more. However by the end of the year they are only put in once a day. It is very important not to run out of steroid drops.

 

How often will I need to be seen after the operation?
Your first visit will be a few days after the operation. Your next visit is usually about 3 weeks later. We then increase the period between visits, often two to three months apart. This will depend on each individual. You can expect to be seen about four times in the first year.

 

Is there anything I should avoid after the operation?
You can do most things, but you must not rub the eye in the first month, as this can dislodge the graft. You may swim after 4 weeks. It is not safe to fly in the first week because of the air bubble in the eye.

 

Could I catch any disease from the transplant?
The medical history of the donor is checked to exclude the following conditions: rabies, Creutzfeldt-Jakob disease [CJD] and diseases of the nervous system of unknown cause. Blood is taken from all donors to exclude hepatitis B, hepatitis C and HIV. While the cornea is in the Eye Bank it is very carefully examined to reduce the risk of infection with bacteria and fungi; as a result of these checks the risk is tiny (much less than 1%). However, because of this tiny risk, once you have had a corneal transplant you will not be able to be a blood or organ donor.

 

How well will I see?
The vision will be much more blurred for the first few days. After a month it should be as good as it was before, and then as the months go on there is normally further improvement up to about a year after the graft. You should not buy any new glasses for two months after the operation as the corneal shape changes.

 

Are there stitches?
The graft itself has no stitches. The entry incision at the edge of the cornea is occasionally stitched and is easily removed in the clinic if necessary. The surgeons at LaserVision are at the forefront of this surgical technique, performing the surgery with a topical (eye drops alone), suture-less technique.

 

How long will the graft last?
Most grafts will last for many years – often for life. Occasionally corneal grafts can fail and become cloudy. The most common cause is corneal graft rejection, and after this corneal endothelial failure (the cells of the cornea fail). The overall 5 and 10-year survival for a full-thickness graft is 90% and 80%, but an endothelial graft may do better than this. Luckily it is relatively easy to repeat an endothelial graft if necessary.

 

What problems should I seek advice about?
Graft rejection is our main concern. This rejection results from your immune system recognising the graft as being “foreign”. The vision becomes blurred and occasionally the eye becomes red, sore, and sensitive to light. This is very treatable, but if not treated early, can lead to permanent graft failure with blurred vision.

 


Your LaserVision consultant surgeon can expertly guide you through the best treatments for you. Each treatment is personalised to achieve the best results.



In association with:
Sheffield Teaching Hospital NHS Foundation Trust, Greater Manchester University Hospitals NHS Foundation Trust