DSEK

Before your procedure, we perform detailed measurements and imaging of your cornea to plan your surgery precisely. You may need to temporarily stop certain medications, and we will likely have you start antibiotic eye drops a day or two before surgery to prevent infection. On the day of surgery, arrange for someone to drive you home afterward, and wear comfortable clothing. Our surgical team will review all instructions with you beforehand to help you feel prepared and confident.

Your surgeon begins by making a small incision at the edge of your cornea, usually about 3 to 5 millimeters long. Using specialized instruments under a surgical microscope, we carefully remove the damaged inner layer of your cornea. The healthy donor tissue is then folded like a taco and gently inserted through the small opening. Once inside your eye, we unfold the donor tissue and position it precisely against the back surface of your cornea. We place an air bubble inside your eye to press the new tissue gently into place, holding it there while the natural healing process begins. Throughout the procedure, you will not feel pain, though you may be aware of some pressure or movement.

The donor tissue we use comes from carefully screened corneas obtained through certified eye banks. These organizations follow strict safety protocols to test for infectious diseases and ensure the quality of every donor cornea. The tissue provides the millions of healthy endothelial cells your eye needs to pump excess fluid out of your cornea and keep it crystal clear. We match the donor tissue for size to fit your eye properly, and we can often customize the tissue thickness based on your specific needs.

The DSEK procedure typically takes 45 to 60 minutes. We perform it as an outpatient procedure in our surgical center, which means you go home the same day after a brief period of observation to ensure your donor tissue is well-positioned.

No, DSEK is performed on an outpatient basis in our surgical center. You will return home a few hours after your procedure. You will need someone to drive you home and stay with you for at least the first 24 hours.

Most patients experience minimal discomfort during and after the procedure thanks to effective local anesthesia. You may feel a scratchy sensation or mild pressure during the surgery, but you should not feel sharp pain. Afterward, some patients notice irritation similar to having something in their eye, which is typically well-controlled with prescribed eye drops and over-the-counter pain relievers if needed.

You should wait until your vision has cleared sufficiently and we have given you approval to drive, which is often within one to two weeks. Do not drive as long as your vision remains blurry or you are using medications that affect your vision. We will assess your vision at your follow-up appointments and let you know when it is safe to resume driving.

Yes, we commonly and safely perform DSEK in eyes that have already undergone cataract surgery with an intraocular lens implant. In fact, many of our DSEK patients have artificial lenses from previous cataract surgery. We ensure your lens is stable and well-positioned before proceeding with your corneal transplant.

Most patients still need glasses for their best possible vision, particularly for reading and detailed close-up work. Some patients experience a mild shift toward farsightedness after surgery, which can be corrected with a new eyeglass prescription once your vision has stabilized, typically 3 to 6 months after your procedure. Your final glasses prescription depends on your eye's unique characteristics and any pre-existing refractive errors.

You will need to lie flat on your back as much as possible for the first 24 to 48 hours after surgery. This positioning uses the air bubble we placed in your eye to hold the new tissue firmly against your cornea as it begins to attach. You can get up to use the bathroom and eat meals, but otherwise, plan to rest on your back. We will give you specific instructions based on how your surgery went.

If your donor tissue partially detaches, we can usually fix it with a simple procedure called rebubbling. This involves injecting more air into your eye to gently float the graft back into its proper position. We perform this in our office, and it takes just a few minutes. Most detachments that are identified and addressed promptly heal successfully without affecting your final vision.

The air bubble we place in your eye and the steroid drops you use after surgery can temporarily raise your eye pressure in some patients. We monitor your eye pressure regularly at all follow-up visits. If your pressure becomes elevated, we can adjust your medications or add pressure-lowering drops to keep it in a safe range. Most pressure elevations are temporary and resolve as you taper off the steroid drops.

Light office work or computer-based tasks can often resume within a few days, depending on your vision and comfort level. You should avoid heavy lifting over 20 pounds, strenuous exercise, contact sports, and activities that involve bending over at the waist for at least two weeks, or until we clear you at a follow-up appointment. Swimming and hot tubs should be avoided for at least one month to reduce infection risk.

Yes, you should postpone air travel until the air bubble in your eye has completely absorbed, which usually takes 7 to 10 days. Changes in cabin pressure during flight could cause the bubble to expand, which might damage your eye or shift the donor tissue. We will let you know when it is safe to fly based on your individual healing progress.

While DSEK can clear up your cornea and remove the cloudiness blocking light from entering your eye, your final visual outcome also depends on the health of your retina and macula at the back of your eye. Conditions like macular degeneration, diabetic retinopathy, or retinal scarring may limit how much vision improvement you experience even after a successful corneal transplant. We evaluate the health of your entire eye before surgery to set realistic expectations about your potential vision.

Both DSEK and DMEK replace the damaged inner layer of your cornea. DMEK uses an even thinner graft that includes only the Descemet's membrane and endothelium, which can provide slightly sharper final vision for some patients. However, DMEK grafts are extremely delicate and have a higher risk of detaching during healing. DMEK also requires more advanced surgical skill. We often prefer DSEK for patients with more complex eyes, previous eye surgeries, or challenging anatomies because it is a more robust and reliable procedure.

DSEK grafts have excellent long-term survival rates, with most remaining clear and functional for many years or even decades. Like your natural endothelial cells, donor cells do slowly decrease in number over time, but the rate is very gradual. Graft rejection is rare but can cause sudden vision loss, redness, light sensitivity, or eye pain. If you experience any of these symptoms, contact our office immediately. When caught early, prompt treatment with steroid drops can often reverse rejection and save your graft.