Fuchs’ Dystrophy & DSEK

The cells of the corneal endothelium are very fragile. Diseases that damage the corneal endothelial layer includes Fuchs’ Dystrophy or trauma following eye surgery (like cataract or glaucoma surgery). Once an endothelial cell dies it will not grow back. If an eye loses too many endothelial cells, it is not able to maintain the proper corneal thickness and clarity.

What is Fuchs’ Dystrophy?

Fuchs’ Dystrophy is an inherited corneal disease where the endothelium becomes less able to control the cornea’s fluid content. In this condition, little collagen bumps called guttata to develop in place of endothelial cells. As you grow older, they grow in size and number and this causes nearby endothelial cells to die off.

Later in life, the loss of cells can result in corneal swelling with loss of corneal clarity and blurred vision. At this time, partial corneal transplant (endothelial keratoplasty) surgery may be considered.

Endothelial Keratoplasty (EK)

EK involves removing the diseased back layer of the cornea: The endothelium along with the Descement membrane. The donor tissue is then carefully prepared and implanted to replace the removed corneal tissue with a new layer of healthy endothelial cells.

An air or gas bubble is placed under the graft to hold it in position. No sutures are used to hold the graft in place. If the graft does not adhere sufficiently, a “re-bubble” procedure to re-inject the gas or air bubble may be necessary within the first few weeks after the initial procedure.

Endothelial Keratoplasty Advantages

EK is a newer procedure than a standard, full thickness corneal transplant. This offers many advantages:

  • By leaving the front layers intact, surface unevenness from the donor tissue is avoided, thus limiting astigmatism
  • EK is a much less invasive procedure than a standard corneal transplant so there are less risks and recovery is shorter – just a few months as opposed to a year
  • Significantly lower risk of rejection as the donor tissue as only a thin layer of the cornea is replaced as opposed to the entire cornea
  • Extensive suturing is not necessary, and this also reduces post-operative risk
  • Vision improvement is evident within weeks

There are two types of endothelial keratoplasty. The most common type is called Descemet stripping automated endothelial keratoplasty (DSAEK) and Descemet membrane endothelial keratoplasty (DMEK).

In DSAEK surgery, the donor tissue consists of the endothelium, Descemet membrane and a small amount of stroma. A newer type of procedure, called Descemet membrane endothelial keratoplasty (DMEK), uses a much thinner layer of donor tissue (No stroma). Because the tissue used in DMEK is extremely thin, fragile and difficult to handle, this procedure is more challenging than DSAEK and is performed not as commonly.

DMEK tends to give better visual results and a quicker visual recovery; however, donor disc dislocations and failures are also more common. Hence, DSAEK is still better suited for eyes with large iris defects, tube shunts, or intraocular lens in front of the iris.

Our Doctors will discuss with you the risks, benefits, and alternatives with regards to your specific corneal problem and work with you to outline a surgical plan that restores and enhances vision while minimizing risk.

Recovery after Endothelial Keratoplasty

Recovery after an endothelial keratoplasty surgery generally takes several months. You will be instructed to lie down on your back, facing the ceiling for the first 24 hours. Recovery depends on the reason for your surgery, your health, type of corneal transplant, your body’s wound healing time, corneal astigmatism and refractive errors. In some cases, patients may wear glasses or contact lens to improve vision.

DSEK Surgery Advantages

DSEK is a newer procedure than a standard, full thickness corneal transplant. This offers many advantages:

  • By leaving the front layers intact, surface unevenness from the donor tissue is avoided, thus limiting astigmatism
  • DSEK is a much less invasive procedure than a standard corneal transplant so there is less risk and recovery is shorter – just a few months as opposed to a year
  • Significantly lower risk of rejection as the donor tissue as only a thin layer of the cornea is replaced as opposed to the entire cornea
  • Extensive suturing is not necessary, and this also reduces post-operative risk
  • Vision improvement is evident within weeks

Our Doctors will discuss with you the risks, benefits, and alternatives with regards to your specific corneal problem and work with you to outline a surgical plan that restores and enhances vision while minimizing risk.