What is the cornea?

The cornea is like a transparent window covering the eye allowing light waves, reflected off objects, to enter the interior of the eye defining our vision. The corneal surface also plays a protective role by keeping foreign particles from entering the eye.  A certain shape or curvature is required in order for light to focus exactly on the retina, rather than in front of it or behind it.

What is a cornea transplant?

The cornea can be affected by many different disorders, significantly diminishing vision. Corneal transplantation (known as a keratoplasty) is recommended when the clarity of the cornea becomes opaque to the degree of causing vision loss or when the cornea's curvature is too steep or flat to be treated with other methods.  A corneal transplant is the replacement of a damaged or diseased cornea (host cornea) by a donor cornea from a certified Eye bank.  Unlike other transplants, the corneal graft does not need to go through extensive typing procedure in order to match donor and host. Donor corneal tissue is selected by factors such as the donor's age, cause of death, duration between the death and transplant, and the presence of donor eye or systemic disease.

During the procedure, your surgeon will carefully remove the central cornea tissue that is damaged or diseased with an instrument called a trephine and replace it with a precisely sized donor corneal graft. The donor graft is anchored to the surrounding host tissue by small hair-thin sutures. The surgery is performed with general or local anesthetia on an outpatient basis for most cases.

What is DSAEK?

Fuch's Dystrophy and bullous keratopathy (corneal edema) are conditions in which the cornea (the front part of the eye) is cloudy. Patients with this condition may benefit from an endothelial corneal transplant.

A patient with Fuchs Dystrophy is likely a candidate for Descemet's Stripping Automated Endothelial Keratoplasty (DSAEK). In Fuchs Dystrophy, the endothelium layer (back layer) of the cornea is failing and is causing the cornea to become swollen and cloudy. The endothelium is the layer of cells on the inside surface of your cornea. It is this layer that needs to be replaced. Until recently, the only way to replace that layer of cells was with a full thickness corneal transplant. Over the last several years, a technique has been developed to replace only the back layer of the cornea (DSAEK) instead of replacing the entire full thickness cornea (Penetrating Keratoplasty). This new transplant technique has been shown to provide good vision and to have many potential advantages over full thickness transplants, including earlier return of vision, less refractive errors, fewer serious complications, and a more stable eye.

DSAEK surgery is scheduled in coordination with the eye bank and hospital operating room. It is performed as an outpatient under local anesthesia. During the surgery a small incision (less than ¼ inch) is made in the sclera (the white part of the eye), and the diseased back portion of the diseased cornea (Descemet's membrane and endothelium) is removed. The healthy back portion of the donor cornea is then inserted through the incision and positioned on the back surface of the host cornea using an air bubble. The small incision is then closed with a small suture and the procedure is completed. The surgical procedure takes about one hour to perform.