Medically reviewed by Dr. Niranjana Bejan Singh. Written to established clinical-education standards (AAO/Mayo/NHS/NEI) and adapted for this hospital. Not a substitute for professional medical advice.
DSEK (Descemet Stripping Endothelial Keratoplasty) and DMEK (Descemet Membrane Endothelial Keratoplasty) are partial-thickness corneal transplant techniques that replace only the innermost layer of the cornea, the endothelium, which normally keeps the cornea clear by pumping out excess fluid. These procedures are used when the endothelium fails, most often due to Fuchs' endothelial dystrophy or after complications from previous eye surgery. Compared with a full-thickness transplant, endothelial keratoplasty uses a smaller incision, fewer or no sutures, and generally allows faster visual recovery.
Who typically needs this
- People with Fuchs' endothelial corneal dystrophy causing corneal swelling and blurred vision.
- Corneal swelling (bullous keratopathy) following cataract surgery or other prior eye surgery.
- Endothelial failure after a previous corneal transplant.
- Suitable when the outer and middle corneal layers remain healthy, since only the innermost layer is replaced.
What to expect
- A small incision is made, and the diseased endothelial layer is stripped away from the inside of the cornea.
- A thin disc of donor tissue containing healthy endothelial cells, thicker for DSEK and ultra-thin for DMEK, is inserted through the incision.
- An air or gas bubble is used to press the new tissue firmly into place against the back of the cornea.
- The patient is asked to lie face-up for a period after surgery to help the graft adhere while the bubble holds it in position.
Recovery
- Positioning, lying on the back for several hours to a day after surgery, is important to keep the new tissue attached.
- Vision often improves within weeks, generally faster than after a full-thickness transplant.
- Eye drops, including steroids, are used for a period afterward to reduce rejection risk and inflammation.
- Follow-up visits confirm that the graft has attached properly; a small proportion of grafts need a repeat air bubble (rebubbling) if they partially detach.
Risks to know about
- Graft detachment is a recognized risk and sometimes requires a repeat air bubble injection to reposition the tissue.
- Rejection of the transplanted endothelial layer can occur, though generally at a lower rate than with full-thickness transplants.
- Raised eye pressure can occur, related to the air or gas bubble or to steroid drops.
- As with any intraocular surgery, infection is a rare but serious possible complication.
Frequently asked questions
What is the difference between DSEK and DMEK?
DMEK transplants an even thinner layer of tissue than DSEK, which can give sharper visual outcomes but is technically more delicate to perform.
Why do I need to lie on my back after surgery?
This position helps the air or gas bubble hold the new tissue against the back of the cornea while it adheres.
How soon will my vision improve?
Many patients notice improvement within a few weeks, though full stabilization can take a few months.
Will I need stitches?
DMEK often needs no sutures at all, and DSEK typically needs very few, unlike a full-thickness transplant.
Ready to see us?
Call the appointment desk, or book online — we will confirm your time by phone.
Sources consulted: AAO — Corneal Transplant Surgery Options, Mayo Clinic — Cornea transplant . General medical information — not a substitute for professional diagnosis. Medically reviewed by Dr. Niranjana Bejan Singh.
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