Descemet's stripping automated endothelial keratoplasty, or DSAEK for short, is a procedure in which only the back layer of a diseased cornea is removed and replaced by donor tissue.  In a normal functioning eye, a layer of cells known as the endothelium sits on the back of the cornea on a membrane called Descemet's membrane.  These cells act as pumps which keep fluid out of the cornea and maintain its clarity.  Certain medical conditions, such as Fuchs dystrophy or trauma, can lead to a decreased functioning of these cells.  Dysfunction of these cell leads to swelling and clouding of the cornea, and is sometimes accompanied by pain.  Advances in surgical techniques have allowed us to remove only the diseased layer of the cornea, and replace it with a thin layer of donor tissue containing healthy cells.  An air bubble is injected into the front of the eye and holds the graft in position for the first few days, until the pumping mechanism of the new cells creates enough suction to hold the graft in place.  Like a standard corneal transplant, this procedure is done on an outpatient basis.  However, with DSAEK there are decreased risks at the time of surgery and quicker recovery times when compared to classical corneal transplants.  Stabilization of vision usually occurs by three months time after surgery.
Corneal SwellingCorneal Appearance After DSAEK (same patient)