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DSAEK is a partial thickness cornea transplant procedure that involves selective removal of the patient’s Descemet membrane and endothelium, followed by transplantation of donor corneal endothelium, in addition to donor corneal stroma. The transplanted tissue is approximately 100-200 microns thick. If the endothelium of the graft comes in contact with any surgical instruments, it will be damaged, and the graft may fail. Therefore, the surgical procedure is designed to avoid contacting the donor endothelium.

A tunneled corneoscleral incision is created and the recipient endothelium and Descemet membrane are removed. The graft is folded and inserted with non-coapting forceps (forceps that do not meet at the tips). An air bubble is then placed in the anterior chamber to support graft adherence.

The procedure is used to treat corneal edema in the setting of endothelial dystrophies, such as Fuchs corneal dystrophy and posterior polymorphous corneal dystrophy, pseudophakic bullous keratopathy, iridocorneal endothelial (ICE) syndrome, endothelial failure in the setting of prior intraocular surgery or of a previous PK graft, and other causes of corneal endothelial dysfunction.

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