DSEK: the pros and cons

Descemet's stripping with endothelial keratoplasty provides significant advantages over penetrating keratoplasty (PK), according to a study published in the March 2006 issue of the Journal of Cataract & Refractive Surgery.

The Price Vision Group, under the direction of Francis Price Jr., MD and Marianne Price, PhD, analysed the outcomes of 200 consecutive DSEK procedures, performed by the same surgeon, in order to establish early challenges associated with the method, as well as techniques required to promote donor tissue adherence.

The technique involved stripping Descemet's membrane and endothelium from the recipient's central cornea and transplanting an 8.0 to 9.0 mm disc of donor endothelium and posterior stroma through a 5.0 mm incision, with sutures used simply to close the incision. Follow-up was seven to 20 months for 124 eyes and two to six months for 76 eyes.

At the study's conclusion, the investigators admitted that the most frequent challenge was inadequate donor attachments. Any incidences of donor detachment were remedied by injecting an air bubble to press the donor against the recipient cornea. While there were seven primary graft failures, only one occurred in the second lot of 100 cases, which primarily used microkeratome-dissected donor tissue. Other, very rare, complications included papillary block glaucoma, cataract development and aqueous misdirection. However, DSEK was performed successfully following LASIK.

The authors concluded that DSEK did indeed offer certain advantages over PK, including more rapid healing, predictable refractive outcomes and enhanced corneal strength and integrity. Though the study group admitted donor adherence was slightly trickier, the procedure itself was technically easier and hence should be less traumatic to anterior chamber structures.