An innovative group of procedures known collectively as Endothelial Keratoplasty (EK) is getting high marks from our doctors at Cornea Associates of Texas. Until recently, cornea transplant patients at our Texas clinics had very few treatment choices if they ever wanted to see clearly again. The most likely option was for them to undergo a full thickness corneal transplant – a complicated procedure that surgically replaces the entire damaged cornea with a donor cornea.
Short for Descemet's Stripping Endothelial Keratoplasty (DSEK or DSAEK), this procedure is performed in our Dallas and Fort Worth, Texas, surgical facilities. DSEK surgery is not nearly as invasive as full-thickness corneal transplantation and requires considerably less recovery time and imports lower risk of rejection. Rather than removing the entire cornea, our physician performing the transplant makes a small incision in the side of the eye and removes only the damaged portion at the back inner dome of the cornea. The surgeon then pushes an extremely thin layer of corneal tissue along with the new cells in place and affixes it to the cornea with a pocket of air. The transplanted cells begin pumping fluid out of the cornea, thus creating a suction that causes them to adhere to the back of the host cornea.
Descements Membrane Endothelial Keratoplasty (DMEK or DMAEK) is an even more recent innovation in corneal transplantation. With all of the advantages of its predecessor DSEK, DMEK can be done through even smaller incisions and visual recovery time is even faster. DMEK has even lower rates of transplant rejection (~2%).
We are excited about EK surgery at Cornea Associates of Texas, having performed these procedures for over a decade now. Rather than facing a potential one-year recovery period (a huge drawback for full thickness corneal transplant patients), the healing time is 1-3 months for EK patients. Our patients from Dallas, Fort Worth and Plano Cornea Associates of Texas locations have access to this procedure.
With all of their advantages, DSAEK and DMAEK do have a few limitations. They work best for a very specific category of vision problems – those that affect only the back layer of the cornea. Indications include:
- Fuch's Endothelial Dystrophy
- Pseudophakic/Aphakic cornea edema or bullous keratopathy
- Endothelial failure after a PKP (full thickness corneal transplant)
- Iridocorneal endothelial (ICE) syndrome
- Any cause of endothelial dysfunction
The most common complication is graft dislocation, with a reported dislocation rate of between 2% and 25% depending upon the study. This requires a re-bubbling of the graft, a secondary follow-up procedure. DSAEK renders the cornea slightly thicker than its original size, which might make future tracking of glaucoma more difficult. DMAEK does not add to the corneal thickness but some glaucoma patients still may not be candidates for DMAEK.
For more information on this major evolution in cornea transplant surgery, contact our Cornea Associates of Texas physicians to inquire about DSAEK and DMAEK in both Dallas, Fort Worth and Plano.