The cornea is the optical window of the eye and must remain clear to maintain good vision. When the endothelium, the inner cell layer of the cornea, stops working, the cornea becomes cloudy. Traditionally, treatment for this condition required replacement of the whole central cornea as in a Penetrating Keratoplasty or Full Thickness cornea transplant. More recently ophthalmologists have developed an alternative known as Descemet’s Stripping with Endothelial Keratoplasty (DSEK) that involves only replacing the innermost layers of the cornea.
Drs. Clinch, Kang, and Shah are specially trained to perform DSEK which replaces only the damaged cell layer instead of replacing the entire thickness of the cornea. With this new technique, the cornea heals much faster and stronger and the patient’s visual recovery is simpler. DSEK is Drs. Clinch, Kang, and Shah’s preferred method of treatment for eligible patients with Fuchs’ dystrophy and pseudophakic bullous keratopathy.
The basic DSEK technique consists of gently stripping off the diseased cell layer lining the inner surface of the cornea. A donor cornea is thinly sliced and the inner portion is folded in half for insertion through a small incision made near the white part of the eye. The surgeon then injects an air bubble into the eye to unfold the donor tissue and press it up into place. The natural pumping action of the donor endothelial cells quickly creates suction, which bonds the donor tissue to the recipient cornea.
Blue area above represents the corneal endothelium and Descemets membrane. Only this part is removed in DSEK rather than the entire thickness of the cornea in a traditional cornea transplant.