The operation

A series of pre-operative measurements and examinations will determine whether the patient is a good candidate for the DSAEK procedure. The surgeon will verify whether the patient suffers from other eye diseases such as cataract, macula degeneration, etc. In most cases the patient will undergo a cataract surgery prior to the final decision of undertaking a DSAEK procedure.

This procedure is done on an outpatient basis. The patient is sedated and given an injection of numbing medication behind the eye. The patient is awake but feels nothing.

In a first step of the procedure the posterior layer (lamella) of the donor cornea is prepared with healthy endothelium. (This tissue, the corneal graft, is provided by a cornea bank.) The posterior layer or lamella is made by means of a keratome (a device adapted from the one which is used for LASIK procedures).

After the local anesthetic has taken effect, the eye is draped in a sterile fashion. During the first part of the operation a very small incision in the corneal limbus is made and the unhealthy endothelial cells are removed (Descemet stripping).

The second part of the procedure involves replacing this unhealthy tissue with the corneal lamella with healthy cells from a donor cornea (endothelial keratoplasty).

In order to make the new tissue stick onto the back of the old cornea, an air bubble is used to completely fill the front part of the eye. The bubble presses the lamella.  The entire intra-operative procedure is performed in 45 minutes.  Patients are told to lie on their backs for the rest of that day and are examined the next morning. The air bubble disappears progressively in the course of the two following days.

Patients are able to return to their normal activities within two weeks with the exception of swimming. An antibiotic eye drop is used for about six weeks post-operatively and a mild steroid eye drop is used for at least a year and more often for the rest of the patient’s life to prevent graft rejection. Fortunately graft rejections are very unusual. Every six months the patient needs to come in for a post-operative check up.

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