Descemet stripping automated endothelial keratoplasty (DSAEK) is a lamellar corneal transplant that replaces the diseased endothelial layer with a thicker donor disc of posterior stroma and endothelium. It is also used for endothelial failure such as in Fuchs’ dystrophy.
Procedure Overview
The surgeon removes the central diseased endothelium and inserts a precut donor lenticule through a small incision. An air or gas bubble holds the graft in place against the back of the cornea while it adheres.
- Technically easier than DMEK but with slightly thicker graft
- Can be combined with cataract surgery in a single operation
- Positioning and postoperative head posture help maintain graft attachment
- Rebubbling is sometimes needed if partial detachment occurs
Outcomes
DSAEK improves corneal clarity and vision with faster recovery than penetrating keratoplasty. Some residual thickness may cause mild hyperopia or reduced maximum visual acuity compared to DMEK.
- Topical steroids are used long term to reduce rejection risk
- Regular review monitors endothelial cell count and graft health
- Rejection presents with redness, pain, and blur and requires urgent treatment
- Choice between DMEK and DSAEK depends on surgeon expertise and eye anatomy
