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DSAEK – A New Surgery for Fuchs’ Dystrophy

Descemet's Stripping Automated Endothelial Keratoplasty (DSAEK)

DSAEK is a corneal surgery procedure for severe cases or corneal disease or for damaged corneas. If you are not familiar with the cornea it is a remarkable structure that helps to focus light and protect the internal structures of the eye. The shape of the cornea is important to the focusing of light on the retina in the back of the eye. A properly shaped cornea and healthy lens will allow this light to focus clearly, providing crisp vision.  It is also important that the cornea remain clear so the light can pass through to the retina without being interrupted.  If the cornea gets hazy or cloudy, or if the shape of the cornea becomes irregular, vision can be impaired.  Some causes of this include age, trauma or disease. When vision is impaired enough to affect a patient’s daily functioning, it may need to be totally or partially replaced by a corneal transplant procedure.

While DSAEK is a relatively new procedure, the surgeons at Coastal Vision have helped pioneer it, already performing numerous surgeries with excellent results. Although DSAEK is a relatively new, but well tested, corneal surgery technique that can help some patients who previously required a full thickness corneal transplant.

The procedure is similar to the traditional cornea transplant because both use donor corneas to replaced damaged or disease corneas. Both the conventional corneal transplant technique and DSAEK require use of a donor cornea, but DSAEK replaces only the damaged posterior section of your cornea. This procedure, which requires minimal suturing, allows more rapid visual restoration, less discomfort, and a reduced risk of sight-threatening complications.

In DSAEK the endothelium is the critical part of the cornea that will be replaced due to damage or disease. It is important to understand a little bit about this part of the cornea before learning what is done in DSAEK surgery. The endothelium is the extremely thin, innermost layer of the cornea, and healthy endothelial cells are required to keep the cornea clear. Fluid will drain from the inside of the eye into the middle of the cornea and the endothelium's primary task is to pump excess fluid back out. Without this pumping action, the stroma would swell with water, become initially hazy and then ultimately opaque.

What Happens in DSAEK Cornea Surgery?

Fuchs’ Dystrophy patients are the primary group of patients needing a DSAEK procedure.  Fuchs’ endothelial dystrophy (FED) is a degenerative disorder of the corneal endothelium leading to corneal edema and loss of vision.  Patients first receive a full evaluation and testing at Coastal Vision Medical so that our doctors can best determine the patient’s treatment options, including the need for DSAEK surgery.  One week prior to surgery, the staff at our Orange County Ophthalmology practice begins the process of procuring donor corneal tissue in preparation for the patient’s DSAEK surgery and schedules all appropriate operating room time at the surgical facility.  

On the day of surgery, the patient will arrive at the surgery center approximately one hour prior to surgery for preparation.  The patient must not eat anything after midnight the day before surgery and will begin pre-operative medications three days prior to surgery as instructed. Prior to the patient’s surgery the surgeon will prepare for surgery by determining the type of tissue to be used and selecting the technique needed to ensure the best surgical outcomes possible. After the approximately one hour surgery, the patient must lie flat on their back so the air can push up into the cornea and hold the new tissue in position. Once the tissue sticks to the cornea, it will begin to function and pump the water out of the cornea, clearing vision.  Vision improves fairly rapidly, with final visual results obtained in approximately 1-6 months after surgery.

The Relationship to Fuchs’ Dystrophy

If you are familiar with Fuchs’ Dystrophy, and you are a patient that requires immediate attention, our Orange County DSAEK eye doctors might be able to help you. In order to start the process of understanding your candidacy for this procedure we will need you to schedule an appointment so that we can examine your eyes. Our doctors have the capability to help struggling patients with this degenerative eye disease. Contact an Orange County DSAEK specialist today at Coastal Vision. 

Fuchs’ dystrophy is an inherited disease of the cornea, where the inner most layer of the cornea, called the endothelium, becomes dysfunctional and may result in decreased vision. The front part of a normal eye is filled with fluid called the aqueous. However, the cornea, which separates the outside air from the aqueous fluid inside the eye, must stay relatively dry in order to maintain its clarity. To accomplish this task, the inside of the cornea is lined with a specialized layer of cells called the endothelium. The endothelial cells function as one-way pumps, drawing fluid out of the cornea and pumping it back inside the eye. By so doing, the cornea, despite being in direct contact with the aqueous eye fluid, stays relatively dry and clear.

In Fuchs’ dystrophy, the endothelial cells are slowly replaced with small collagen bumps called guttata. Guttata may first appear in the cornea in the 20s and 30s, though rarely cause any symptoms until later in life. As a person ages, the guttata may slowly increase in number and size. In the process, the endothelial cells surrounding them may slowly die. When a critical number of endothelial cells are lost, usually by the age of 50 to 60 years, the pump function of the endothelium may be overwhelmed and the cornea starts to swell with eye fluid. As the swelling worsens, the vision may start to decrease. In cases where large amounts of guttata exist on the cornea, the vision may also become compromised even without corneal swelling from irregular scattering of light passing through the dense guttata layer.

Advantages to DSAEK

According to an acclaimed US ophthalmologist, preliminary studies show that the risk of rejection is lower in DSEK than in full-thickness transplant. It is so exciting in our field right now to be able to offer patients this improved technology that gives them increased safety and faster recovery with exceptional results. Another major advantage of the DSEK cornea procedure is the fact that it allows a far larger segment of the population to donate their corneas, including older donors and some who have had LASIK or even a scar on their cornea, as such a small section of endothelial cells is needed for the transplant.”

The Experience of Dr. Dan B. Tran

Dr. Dan B. TranEye doctors, physicians, and high-level executives alike, have chosen Dr. Tran for his skills. Those who know the industry well prefer to have Dr. Tran as their surgeon.  Dr. Dan Tran takes great pleasure in restoring vision for his patients, family, and friends, and in witnessing the impact that it has on their lives. If you are seeking the best in Orange County DSAEK surgery call Dr. Tran at Coastal Vision Medical Group.