Descemet’s Stripping Automated Endothelial Keratoplasty (DSAEK or DSEK) is a remarkable improvement in corneal transplantation. One of the dangers of a cornea transplant is the possibility of rejection. Even when a compatible cornea is found, rejection is still possible. DSAEK is a form of corneal transplant whereby only a portion of the cornea is replaced, lowering the chance of rejection and shortening the postoperative recovery time.
The cornea, although quite thin, consists of several anatomically and physiologically distinct layers. The layer that is responsible for many diseases, like Fuchs’ dystrophy, is the corneal endothelium. DSAEK replaces only a portion of the cornea, including the portion that contains the endothelium. This provides the same remedy as a full corneal transplant (i.e. penetrating keratoplasty or PK), but generally is considered safer for patients.
One caveat of the DSAEK procedure is that DSAEK technically challenging, and it is recommended that a corneal specialist perform the procedure rather than an ophthalmologist of a different subspecialty. One can compare a similar procedure, Descemet’s Membrane Endothelial Keratoplasty, which replaces only the endothelium. Note that we find that this procedure, although extremely good concerning transplant rejection rates, can provide some difficulty in transplanting a layer of tissue that is nearly too thin to handle. The risk of losing a matching transplant are higher, therefore we do not perform this procedure.