Rory A. Myer, M.D.

Tomoka Eye Associates Cornea Eye Specialists Dr. Rory Myer is proud to offer a corneal
transplant treatment known as DSEK, or Descemet’s Stripping Endothelial Keratoplasty.

Only patients with endothelial cell problems are candidates for DSEK  Patients with corneal scarring or other conditions will still require the full-thickness corneal transplantation procedure.

Good candidates for DSEK  include:

o    Fuchs’ endothelial dystrophy

o    Bullous keratopathy

o    Posterior polymorphous membrane dystrophy

o    Iridocorneal endothelial (ICE) syndrome

o    Failed endothelial keratoplasty

The human cornea is made up of three layers:

  • The outer epithelial layer
  • The middle stromal layer
  • The inner endothelial layer

The inner endothelial layer is made of a single layer of cells and sits on a thin tissue
strip called Descemet’s membrane. The role of the endothelial layer is to pump fluid
out of the cornea to keep your cornea (and your vision) clear. If the endothelial layer is
lost or stops working correctly, the cornea can fill with fluid, become cloudy or swollen,
and affect your vision.

How is the endothelial layer lost?

The endothelial layer can be lost or negatively affected due to:

  • Aging
  • Inherited diseases (such as Fuchs’ Corneal Dystrophy)
  • Trauma
  • Previous intraocular surgery

Once a critical amount of the endothelial layer is lost, the cornea swells and becomes
cloudy. At this point, medical treatment is no longer helpful, and a corneal operation is
necessary. For most patients, the middle stromal layer and outer epithelium layer
remain healthy, even as the endothelial layer is affected.

The DSEK Surgery

For your DSEK surgery, donor corneal tissue is obtained from an Eye Bank. Before your
surgery, you will be given eye drops and an IV line will help you sleep for a short time.
The eye is anesthetized and a small incision is made in your cornea. Your cornea is
gently marked on the outside to guide the removal of the affected Descemet’s
membrane. One the membrane is removed, the new donor cornea is cut to match the
size of the removed membrane. The new cornea is then secured in the correct place
using a small air bubble, which seals the membrane in place. Finally, the incision sites
are closed and the pressure of your eye is checked to make sure it’s normal following
the DSEK procedure.

Pros and Cons of the DSEK Procedure

There are several major advantages to the DSEK procedure over a traditional corneal

  • The operation is faster (30 to 45 minutes).
  • The incision is smaller
  • The procedure location is more stable and less likely to break open from trauma.
  • There is very little postoperative astigmatism.
  • Recovery takes only about 1 to 2 months.
  • Since only the thin inner layer of the cornea is replaced, over 90% of the patient’s
    own cornea remains behind. This adds to greater structural integrity and reduced
    chance of rejection.

DSEK may not be an ideal option for everyone. Patients with prior corneal scarring are
not good candidates for DSEK. There are also some risks involved with the DSEK

  • Since DSEK has been done since 2005, there is no long-term follow-up.
  • There is a 10% risk of the graft becoming displaced within the first few days or weeks
    after surgery. This means the graft must be redone with a replacement air bubble in
    the eye.
  • There is minor risk of swelling, infection, and hemorrhaging, and extremely minor
    risk of poor vision quality or total loss of vision.
  • If the DSEK operation fails, the operation can be repeated with another button of
    donor endothelium.
  • If the DSEK fails, a traditional corneal transplant can be done.

Talk to Dr Rory Myer at Tomoka Eye Associates to learn more about our revolutionary
DSEK procedure and whether it can improve your vision.