The cornea is a transparent dome on the front of the eye. In case of diseases that are characterized by a dysfunctional endothelium (the posterior surface of the cornea), the cornea becomes cloudy and swollen. Because these cells are not capable of dividing or repairing themselves, they must be replaced with healthy donor tissue obtained from the eye bank.
DSAEK is indicated for those patients who have corneal pathology located on the endothelial layer. This most commonly occurs in patients who have sustained trauma to the endothelial layer during complicated cataract surgery or patients who have inherent disease of the corneal endothelium known as Fuch’s endothelial dystrophy.
For the past 50 years, penetrating keratoplasty (PKP), or replacement of the full thickness of the cornea, has been the standard care for patients with corneal endothelial disease. While the anatomical results are excellent, the visual results judged by speed, quality and predictability are poor. A typical corneal transplant patient may not see well up to 2 years. It is very difficult to predict the final curvature of the cornea, so after surgery, glasses or contact lenses are required in the vast majority of cases. Sutures remain in place for a long time, and a ruptured wound is always a serious risk. Patients with bilateral disease often must wait a long time for treatment of their second eye until their first eye resolves.
Recently, however, corneal specialists have begun to replace only the diseased layer of the cornea, rather than its full thickness. Not only is this technique faster, the healing time shorter and the pain lessened (or removed), the procedure is also providing better vision for the patients.
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