Traditionally, doctors have replaced damaged corneas with donor tissue. Today, corneal specialists can isolate the diseased inner layer of the cornea and replace the layer through a process called Descemet’s Stripping Automated Endothelial Keratoplasty (DSAEK). Corneal transplant often results in a prolonged recovery time and post-operative astigmatism, yet DSAEK requires only a tiny incision and one suture. If your inner corneal layer is swollen and not working properly, you may be a candidate for DSAEK.
Before the Surgery
Currently, all corneal tissue used for DSAEK is from donors. All corneas are screened for infectious diseases, so you will have to wait for a period of about four to six weeks before your DSAEK surgery. Your outpatient eye center will contact you to let you know that a donor has been found, and you will be given instructions for arrival time for surgery. You will not be allowed to eat or drink anything after midnight.
Well before your surgery, your surgeon will ask for a list of your current medications. You may be required to have an EKG, chest x-rays and blood samples before your surgery.
During the Surgery
You should plan on being at your outpatient surgery center for at least five hours on the day of surgery and arrange for someone to drive you to and from your procedure. Most likely, you will be given a local anesthesia, which will numb your eye and prevent movement. In rare cases, you may be administered general anesthesia.
Your surgeon will place sterile drapes over your eye to provide adequate ventilation and will then make a small incision on the side of your cornea. The inner layer of your cornea will be replaced by the donor layer. The entire procedure takes about one hour. The donor cornea is held in place by the eye's own suction power. The front of your cornea will not have any sutures or incisions, so that will help you have a quicker recovery time.
After the Surgery
You will stay at the surgery center for at least an hour after surgery for monitoring. You should keep your eye dressing in place and wear a protective eye shield at night. The following day, your doctor will see you for a post-op visit. You may wear eyeglasses during the day to protect your eye, but you must continue to wear the eye shield at night. You probably will not have much pain after surgery, but you will have to put antibiotic, dilating and steroid drops in your eyes to prevent infection.
In contrast to a typical corneal transplant when you may not see well for up to a year, you should expect to have good vision within a few months or even several weeks after DSAEK. Because the recovery time is so much quicker, you may be considered for a treatment of your other eye much sooner (if necessary). It is not certain, but many doctors suspect that there is less risk of rejection of the foreign tissue if only a part of the cornea is replaced instead of the entire cornea. Final results from DSAEK are not conclusive until many months later, but you will visit your doctor several times during the first year after surgery for continued follow-up.