Is DSAEK Corneal Transplant: Right For You?

Preparation for a DSAEK corneal transplant begins with a comprehensive evaluation to confirm that the patient is an ideal candidate for the procedure. The preoperative process includes:

• Medical and Ocular History Review: Detailed documentation of your symptoms, previous surgeries, and overall health.
• Diagnostic Workup: Tests such as slit lamp examination, specular microscopy, pachymetry, and anterior segment OCT ensure that the eye’s condition is thoroughly evaluated.
• Donor Tissue Procurement: Once you are confirmed as a suitable candidate, donor tissue is sourced from certified eye banks. For DSAEK, donor tissue preparation involves creating a partial-thickness graft containing the posterior stroma, Descemet’s membrane, and endothelium. This tissue is carefully dissected using an automated microkeratome, which provides uniform graft thickness.
• Preoperative Instructions: You may be required to undergo a laser peripheral iridotomy before surgery. This measure helps prevent postoperative intraocular pressure spikes. Additionally, you will be informed about medication regimens and advised to refrain from any activities that could affect your eye in the days leading up to the procedure.

The DSAEK procedure is typically performed under local or general anesthesia and takes about 45 minutes. The operating room is equipped with state-of-the-art instruments to provide a high level of precision. The steps include:

• Corneal Incision: A small, self-sealing sclero-corneal incision is made. This minimizes trauma and negates the need for sutures, promoting faster healing.
• Stripping of Diseased Tissue: The surgeon carefully removes the diseased Descemet’s membrane and dysfunctional endothelium using specially designed instruments. 
• Donor Tissue Preparation and Insertion: The donor graft, prepared from a healthy corneoscleral button, is prepared to the correct diameter. The graft is then stained with Trypan Blue to enhance visualization. Following which it is inserted. 
• Graft Unfolding and Positioning: Once inside, the donor tissue unfolds in the recipient anterior chamber. The surgeon then carefully centers the graft using techniques such as brushing, tapping, or sweeping. A small air bubble is introduced to press the graft firmly against the posterior host stroma.
• Final Air Replacement: After confirming that the donor tissue is adequately attached with minimal interface fluid, excess air is gently removed and replaced with a balanced salt solution (BSS). A tiny air bubble is left in place to further stabilize the graft during the crucial first 24 hours post-surgery.

This meticulous intraoperative protocol ensures that the new tissue adheres properly, setting the stage for the restoration of the cornea’s natural clarity and function.

After the procedure, careful postoperative management is essential to guarantee the best outcomes and to minimize complications.

The following steps are crucial during the recovery phase:

• Immediate Recovery: Patients are monitored intensively for the first hour after surgery. To facilitate graft stabilization, you will be instructed to lie on your back allowing the residual air bubble to press the graft against the host stroma.
• Medications and Eye Drops: Broad-spectrum antibiotics are used to prevent infection, while steroid eye drops help reduce inflammation and lower the risk of graft rejection. 
• Follow-Up Examinations: The cornea surgeon will schedule multiple follow-up visits to monitor the graft through slit lamp, check intraocular pressure, assess central corneal thickness, and evaluate overall adhesion using anterior segment OCT. These visits help detect early signs of rejection or complications.
• Postoperative Instructions: Patients are advised to avoid rubbing the eye for at least two weeks and to remain lying down face up for an additional day or more to maximize graft adherence. Additionally, activities that might strain the eye, such as heavy lifting or vigorous exercise, should be limited for 3 to 4 weeks.