What DSAEK is going on? An alternative to penetrating keratoplasty for endothelial dysfunction

Traditionally, penetrating keratoplasty (PK) has been the only surgical treatment for patients with Fuchs' dystrophy and pseudophakic bullous keratopathy. Over the last several years, an alternative technique has become viable. Descemet's stripping automated endothelial keratoplasty (DSAEK) is a partial transplant that replaces only posterior corneal tissue, leaving the healthy anterior cornea intact.

A retrospective review of the current literature was conducted.

Initially, DSAEK surgeons were plagued by high graft dislocation and failure rates. However, modifications have been made to drastically reduce these numbers. With a predictable refractive error, lower rejection rates, and faster recovery time, DSAEK appears ready to surpass PK as the primary surgical option for endothelial dysfunction.

Corneal endothelial dysfunction is a problem more commonly seen in the middle-age and elderly populations. Until recently, the only option available for these patients was a full-thickness PK. DSAEK is a promising new alternative that preserves the normal healthy cornea, allowing a faster and more stable recovery. This article discusses the indications, procedure, and management of DSAEK and comparisons to PK.