By Dr. Geet Shah, Ophthalmology
Descemet Stripping Endothelial Keratoplasty (DSEK) and Descemet Membrane Endothelial Keratoplasty (DMEK) are types of cornea transplant surgery. They are a high tech and advanced technology for eye surgery.
Cornea is comprised of 5 layers of tissues. Traditionally, the cornea transplant was done with the Penetrating Keratoplasty (PKP) method, where the entire thickness of the cornea with five layers is removed and replaced with the thickness of the donor cornea. This method is successful and still in use. But, cornea transplant is a very delicate procedure, and even a small trauma can cause eye loss. Also, the suture in the eyes causes eyesight issues for the patients after surgery.
To overcome these factors, the newest generation of surgeons are using the Descemet Stripping Endothelial Keratoplasty (DESK) and Descemet Membrane Endothelial Keratoplasty (DMEK) methods for operating cornea. These procedures are safe and only a partial thickness of the cornea is removed. The operation is done with a small incision. In DSEK, a very small and thin layer of cornea tissue, around 100 microns, is removed and replaced with a healthy layer of tissue from the donor. In DMEK, the thick layer of corneal tissue which is very close to the cornea is removed and replaced.
Advantages of DSEK and DMEK:
Some of the advantages of opting for DSEK and DMEK methods are-
Safe Procedure: DSEK and DMEK are very safe as compared to the PKP method. These procedures only require a small incision on the sides of the cornea. The layers of tissues that are dead and need replacement are pulled off and folded into the container. Meanwhile, the surgeons prepare the cornea of the donor in the fluid-filled tray. The donor’s tissue is then used to replace the layer of cornea tissue in the patient carefully. The operation requires less time as compared to the PKP method and does not need to remove all five layers of tissue. Small incision requires less or nearly no suture.
Quick Recovery: The time frame for vision recovery is much faster in DSEK and DMEK as compared to the PKP method. In a full thickness corneal transplant, the vision is restored completely after only one year. But in DSEK, the recovery may take only three months. In DMEK, the vision is restored in a week, and the patient can attain the full vision or 6/6 vision in a week.
Less Sutures, Less Refraction: In DSEK, a very few stitches are used, while in DMEK, no sutures are made. Having no suture or less suture is beneficial for patients since there are fewer chances of eyesight problems post-surgery. With fewer sutures, there is also no chance of infection or irritation. The patient can recover from surgery quickly, and post-surgery maintenance is also less. Generally, in the PKP method, many sutures are made which require patients to wear contact lenses after the operation. Since the front surface is not changed in the DSEK and DMEK, ocular balance is better between eyes.
Limited Restrictions Post Surgery: After the DSEK and DMEK procedures, the patients are required to wear an eye patch and lie straight and look upwards for the entire day. It helps the air bubble in the cornea to remain in the center and supports the tissue to adjust. A person is not allowed to bend below the stomach and lift heavy objects for at least 3 weeks.
Both DSEK and DMEK are partial corneal transplantation methods in which the inner layer tissue of cornea is replaced or removed with the donor tissue. However, it totally depends upon the condition of the patient which method to opt for. This is why one should always consult an ophthalmologist before opting for these methods. He will advise the patient to opt for best treatment methods depending upon his/her condition. It is also advisable to follow the post instructions prescribed by the doctor or surgeons for better results.