The normal cornea is made of three basic layers. The epithelial cell layer, the stromal layer and the endothelial cell layer.
Ophthalmic researchers and surgeons have long recognized that for many patients needing a corneal transplant, only the diseased or missing endothelial cell layer needed to be replaced as the stromal and epithelial cell layers were normal. The endothelial layer is the deepest layer of the cornea and is composed of a single layer of thousands of small fluid pumping cells. These endothelial pump cells are responsible for pumping fluid out of the cornea so it can remain clear and thin and provide good vision for the eye. If a critical number of endothelial cells become dysfunctional, damaged, or destroyed, the cornea fills up with fluid and becomes swollen and cloudy and causes blurry vision.

When this occurs, a corneal transplant operation is indicated. Prior to the DSEK procedure, these patients would receive the standard full(all 3 layers) thickness corneal transplant(see corneal transplant section). Now, however, these patients are treated with the newer DSEK corneal transplantprocedure.
This new technique appears to be a significant improvement over the standard operation. The surgical skill and expertise required is the same, but the surgery itself takes less time with an experienced surgeon, involves a smaller surgical incision, requires far fewer sutures, heals faster and more reliably, and the vision returns faster than with a standard full thickness corneal transplant.

The procedure involves:
1) The patients endothelial layer is stripped from the rest of the cornea

2) The donor endothelium is folded like a taco and inserted into the eye through a small corneal incision

3) An air bubble is injected into the eye to push the donor endothelium up against the posterior surface of the patients cornea

4) The pumping action of the new donor endothelium creates a suction shich bonds the donor tissue to the patients own cornea


You should be up and around immediately after surgery. When the DSEK procedure is performed, you will be asked to remain flat on your back for 24-48 hours after surgery ( except for short intervals to eat and go to the bathroom).For the DSEK procedure, vision improves slowly and reaches its peak in 4-6 months.

Despite the most advanced surgical techniques and the most expert surgeons, complications can and do occur. The most serious complications are less common and the lesser complications are usually treatable.

Those risks include, but are not limited to:

Loss of vision, loss of the eye itself, loss of vitreous, nucleus or capsule, irregular pupil, retinal detachment, retinal tear, macular edema, wound leaks, infection, malposition or later movement of the intraocular lens, inability to place the intraocular lens, infection, hemorrhage in (explusive) or behind (retro-bulbar) the eye, glaucoma, rejection, graft failure, high post-operative astigmatism, the need to wear glasses/contact lenses after surgery, the need for later astigmatism surgery or repeat transplant, unexplained poor vision, double vision, lid droop, and halos or glare, especially at night. Dislocation of the donor graft, in DSEK, may lead to the need for re-positioning or replacement of the graft or in some cases a full standard corneal transplant.

Anesthesia related complications include, but are not limited to: perforation of the globe,
drooping lid, cardiac irregularities, respiratory depression, hypotension, nerve damage, hemorrhage or drug reactions which can lead to loss of vision, loss of the eye, or loss of life. These complications can occur at surgery or at a later time.