About DSAEK


The cornea is a remarkable structure that helps to focus light and protect the internal structures of the eye. The shape of the cornea is important to the focusing of light on the retina in the back of the eye.  A properly shaped cornea and healthy lens will allow this light to focus clearly, providing crisp vision.  It is also important that the cornea remain clear so the light can pass through to the retina without being interrupted.  If the cornea gets hazy or cloudy, or if the shape of the cornea becomes irregular, vision can be impaired.  Some causes of this include age, trauma or disease.  When vision is impaired enough to affect a patient’s daily functioning, it may need to be totally or partially replaced by a corneal transplant procedure.

New technologies have made this an exciting time for corneal transplantation.  Traditional corneal transplantation, known as Penetrating Keratoplasty (PK), is a highly refined procedure with positive overall outcomes.  Traditional corneal transplantation techniques have evolved as well, allowing surgeons to provide even newer techniques, such as DSAEK, to patients with specific corneal needs.

Descemet's Stripping Automated Endothelial Keratoplasty (DSAEK)

A very common cause of a cloudy cornea is a damaged inside, or endothelial, layer of the cornea.  The endothelial layer is one cell layer thick and can be damaged by surgery or trauma or the cells can die too quickly over time (a condition known as Fuchs' Dystrophy).  When there are not enough endothelial cells, water can build in the cornea causing cloudy vision and vision loss.  DSAEK is a highly refined technique that replaces just the endothelial layer of the cornea, allowing surgeons to target the specific cause of the patient’s vision loss.  In the DSAEK procedure the damaged cells are stripped from the patient’s eye and replaced with a very thin back portion of a donor cornea.  This procedure allows your surgeon to literally replace only the damaged area of cornea, allowing a more precise treatment and better overall results.  Your surgeon uses an air bubble technique to hold the new tissue in place in the eye for the entire day of surgery so that no sutures are needed.

What to expect

Fuchs’ Dystrophy patients are the primary group of patients needing a DSAEK procedure.  Fuchs’ endothelial dystrophy (FED) is a degenerative disorder of the corneal endothelium leading to corneal edema and loss of vision.  Patients first receive a full evaluation and testing at Carolina Cataract & Laser Center so that Dr. Vroman and Dr. Budev can best determine the patient’s treatment options, including the need for DSAEK surgery.  One week prior to surgery the staff at Carolina Cataract & Laser Center begins the process of procuring donor corneal tissue in preparation for the patient’s DSAEK surgery and schedules all appropriate OR time at the surgical facility.  As the statewide medical director of Lifepoint Eye Bank, David Vroman, MD, is not only one of the two Carolina Cataract & Laser Center surgeons performing these DSAEK procedures, he also provides statewide oversight of the entire corneal tissue program, ensuring the best quality possible for tissue preparation and patient safety.

On the day of surgery, the patient will arrive at the surgery center approximately one hour prior to surgery for preparation.  The patient must not eat anything after midnight the day before surgery and will begin pre-operative medications three days prior to surgery as instructed.  Prior to the patient’s surgery the surgeon will prepare for surgery by determining the type of tissue to be used and selecting the technique needed to ensure the best surgical outcomes possible.  After the approximately one hour surgery, the patient must lie flat on their back so the air can push up into the cornea and hold the new tissue in position.  Once the tissue sticks to the cornea, it will begin to function and pump the water out of the cornea, clearing vision.  Vision improves fairly rapidly, with final visual results obtained in approximately 1-6 months after surgery.  Patients of Carolina Cataract & Laser Center are showing remarkable results with the DSAEK procedure, with most achieving 20/40 vision or better within the first three months after surgery.  As patient results will vary, glasses are prescribed as needed during the post-operative exam. Patients will return to the Carolina Cataract & Laser Center clinic for follow up at one day after surgery, one week after surgery, three weeks and then as specified by the surgeon.

As with any operative experience, there are always risks and benefits which patients will discuss in detail with the surgeon prior to surgery.  If at any time after surgery the patient experiences redness, pain, loss of vision or any other concerns, our office should be contacted immediately at (843) 797-3676.

About DSAEK

New technologies have made this an exciting time for corneal transplantation. Traditional corneal transplantation, known as Penetrating Keratoplasty (PK), is a highly refined procedure with positive overall outcomes. Traditional corneal transplantation techniques have evolved as well, allowing surgeons to provide even newer techniques, such as DSAEK, to patients with specific corneal needs.

Corneal Transplantation

The cornea is a remarkable structure that helps to focus light and protect the internal structures of your eye. The shape of the cornea is important to the focusing of light on the retina in the back of the eye. A properly shaped cornea and healthy lens will allow this light to focus clearly, providing crisp vision.

Surgeons

David T Vroman, MD A fellowship trained cornea, cataract and refractive surgeon.

Millin C Budev, MDA Board Certified eye surgeon and managing partner of Carolina Cataract & Laser Center.

Patient Information

Carolina Cataract & Laser Center surgeons David Vroman, MD and Millin Budev, MD currently perform all corneal transplant and DSAEK procedures at the Trident Eye Surgery Center in North Charleston.