What is Sutureless corneal transplants ?

DSEK( Descemets Stripping Endothelial Keratoplasty)refers to a new method of advanced corneal surgery, wherein the dysfunctional endothelial layer of the cornea is selectively replaced with healthy donor tissue, without the need for surface incisions or sutures. Tectonically the cornea is much stronger following DSEK as compared to conventional full thickness corneal transplant.

DSMEK and DSEK are corneal transplant procedures to replace damaged, cloudy cells in the cornea with healthy cells from a donor.

This minimally invasive procedure has revolutionized corneal grafting for conditions such as:

• Fuchs Endothelial Dystrophy
• Pseudophakic Bullous Keratopathy

Unlike a traditional full thickness graft where a cornea is completely removed and a new one stitched in, this procedure involves only replacing the innermost layer of the cornea through a small (4mm) incision. This is a more recently developed procedure (known as DSEK or DSAEK)) that involves only replacing the innermost layers of the cornea rather than the whole cornea as in a Penetrating Keratoplasty or Full Thickness graft. In conditions such as Fuchs endothelial Dystrophy, the innermost layer, the endothelium is diseased. The rest of the cornea is normal. Previously to replace the valuable endothelial layer the whole central cornea was removed and replaced with a donor cornea. This technique of a full thickness corneal graft was also known as a Penetrating Keratoplasty.

The Procedure

The procedure involves peeling off the inner two layers of the diseased cornea. A donor cornea is then split with a sophisticated automated device creating a thin segment of the inner two layers and a small portion of stroma the mains substance of the cornea. This ultrathin 3 layer donor is inserted into the eye using instrumentation developed by surgeons at Centre for Sight. The graft inside the eye is centred and using an air bubble floated up to stick onto the inside of the cornea replacing the diseased layers removed earlier. The procedure is technically challenging, however can be accomplished very quickly often with no stitches at all!

The procedure is now the Gold Standard and performed routinely at Centre for Sight and simple but effective instrumentation has been developed by our surgeons to make the process easier.

Advantages

• Closed eye surgery
• Rapid surgery
• Rapid visual recovery
• Easily replaceable

Sutureless corneal transplants – DSEK/DMEK