DSEK (Descemet Stripping Endothelial Keratoplasty)

DSEK, also known as DSAEK (Descemet stripping automated endothelial keratoplasty), is a partial-thickness corneal transplant designed to replace only the damaged inner layer of the cornea. The cornea has five distinct layers, and the endothelium is the thin, single-cell layer on its inner surface. Endothelial cells act as tiny pumps that remove excess fluid from the cornea, keeping it thin, smooth, and transparent. When these cells are damaged or lost, they do not regenerate on their own, and fluid begins to accumulate within the cornea. According to the EBAA 2024 Statistical Report, endothelial keratoplasty procedures like DSEK account for a significant portion of all corneal transplants performed in the United States.

A traditional penetrating keratoplasty (PKP) involves removing and replacing all layers of the cornea. DSEK replaces only the endothelium along with a thin layer of posterior stromal tissue, leaving the front and middle layers of your cornea intact. This selective approach results in a smaller incision, faster healing, a more stable eye structure, and significantly less surgically induced astigmatism.

Healthy corneal endothelial cells maintain a delicate balance of fluid within the cornea. An adult eye typically has a cell density of roughly 2,000 to 3,000 cells per square millimeter, and these cells gradually decline with age. DSEK restores this balance by introducing a fresh layer of donor endothelial cells that resume the pumping function your own cells can no longer perform.

Because only the inner layers are replaced, the eye retains much of its structural integrity after DSEK. This translates to faster healing, substantially less surgically induced astigmatism, and a lower risk of traumatic wound complications. Most patients experience a lower rate of graft rejection compared to full-thickness corneal transplants.

Most patients notice some improvement in vision within the first few weeks, though full visual recovery after DSEK typically takes three to six months as the cornea gradually clears and stabilizes. You will use prescription eye drops, including anti-rejection medications, for several months following surgery.

Both DSEK and DMEK are endothelial keratoplasty techniques, but they differ in the thickness of the donor tissue transplanted. DMEK uses only Descemet's membrane and the endothelium without any stromal tissue, which can result in slightly faster visual recovery and sharper final acuity. However, DMEK tissue is more delicate, leading to a higher rate of graft detachment. Learn more about the differences between DMEK and DSAEK.

The most common early complication is partial graft dislocation, which occurs when the donor tissue separates from the recipient cornea. This typically requires a brief re-bubble procedure to reattach the graft. Other potential risks include graft rejection, infection, elevated eye pressure from the air bubble, and primary graft failure.

DSEK grafts have demonstrated excellent longevity, with many lasting 15 to 20 years or longer. Graft survival depends on factors including the health of the donor tissue, the underlying condition being treated, and consistent use of anti-rejection medications as prescribed.