Keratoplasty DSEK- A New Alternative to Full Cornea Transplant

Of India’s 10 million blind people, 15 to 20% have lost sight because of corneal opacity. Every year about 25,000 to 30,000 are added to this list of treatable blindness.  

 

Cornea is a transparent dome on the front of the eye. The cornea is the clear dome that makes up the front of your eye. Normally, when looking straight on at the eye, you look right through the cornea and see the colored iris and black pupil of the eye.

 

Corneal edema (swelling) produces decreased vision due to loss of transparency of this normally clear tissue. The swelling is due to a loss of endothelium, a thin layer of cells found on the back surface of the cornea. These cells are not capable of repairing themselves. The only treatment for visually significant corneal swelling is to replace these cells.

 

DSEK is a way of performing a safer corneal transplant than the standard Penetrating Keratoplasty (PKP).

 

In standard treatments the surgeon removes the entire diseased cornea and stitches a new one using a donor’s cornea by creating a circular opening in the front of the eye that requires many stitches. DSEK replaces only the damaged inner layer of cells (endothelial layer), leaving the remainder of the cornea undisturbed.

 

 

DSEK	PKP
Only drops in eyes; may need mild sedative.	General anesthesia
Only diseased layer (endothelium) removed and replaced.	A circle of all layers of cornea removed and replaced.
No stitches in eye; or very few	Nylon stitches surround entire transplant.
Less astigmatism and distortion of vision and less change in the eyeglass prescription	Distorted vision after surgery needing change in eyeglass prescription
24 hours post-surgery- functional vision, some light sensitivity. Eye appears as usual.	24-hours post-surgery- severe light sensitivity. Very limited vision. Feeling of foreign object lodged in eye. Eyelid swollen and reddened.
One week post-op uncorrected vision good.	One week post-op light sensitivity continues. Vision limited to very wavy big “E” atop chart.
One month post-op – Vision improvement seen.	One month post-op- No vision improvement.
Usual recovery is in one month	Usual recovery is at 12 months
Needs a small incision	Needs a complete opening
Little or no bleeding and reduced risk of infection	Chance of bleeding during the surgery and infection afterwards
A stronger eye after surgery as no stitches	Eye susceptible to injury from trauma as many stitches
There are fewer restrictions on physical activity after the surgery	Physical activity after the surgery is very limited

 Who needs DSEK?

 

.

 

Q Do I need to get hospitalized for the DSEK procedure?
Ans. It is done as a day care procedure.  (You go home the same day.)

Q How long does the procedure last?
Ans. The patient will be in the hospital approximately for 4 – 4 1/2 hours

Q When will I need to return for a follow up clinic visit?
Ans. The first post procedure visit is on the next day and then as per the doctors instructions. (usually weekly for first 3 visits). If from out of Mumbai, this has to be planned well as it depends on the cornea availability.

Q When will I see an improvement in my vision?
Ans.  Most notice improvement in their vision during the first two weeks after surgery with continued improvement during the next four to six weeks. Some DSEK patients may not notice visual improvement as quickly as they would like, because they have other ocular conditions such as cataract or retinal problems that must be addressed.
 
Q Can my DSEK transplant undergo a rejection?
Ans  Yes, rarely, however, most rejections are successfully treated by using steroid eye drops. Sooner a rejection is treated the better chance for transplant survival.