DSEK vs DMEK Surgery

What is the difference between DSEK and DMEK, and other FAQs

Endothelial Keratoplasty (DSEK & DMEK) Surgery

Endothelial Keratoplasty (EK) is a cornea transplant technique that can restore lost vision when the endothelium, the innermost layer of cells of the cornea, are no longer functioning adequately.

There are a two variants of EK surgery:

  • Descemets’ Stripping Automated Endothelial Keratoplasty (DSEK)

  • Descemets’ Membrane Endothelial Keratoplasty (DMEK)

Medical conditions including Fuchs’ dystrophy, bullous keratopathy, iridocorneal endothelial (ICE) syndrome, or other endothelial disorders may cause blurry or cloudy vision and glare. An EK procedure selectively replaces only the diseased layer of the cornea, leaving healthy areas intact.

What is the difference between a DSAEK surgery and DMEK surgery?

A Descemets’ membrane endothelial keratoplasty (DMEK) is very similar to DSAEK, except that the implanted donor tissue does not include any stromal tissue. DMEK surgery is an exciting option to treat decreased vision and swollen cloudy corneas, and it is a pure replacement of endothelium. DMEK is the most anatomical repair of the three generations of corneal transplantation with just one cell layer and a thin membrane, all of which are only 15 to 20 microns thick.

DMEK Procedure

  • Transplanted Cornea: A 15-20 microns layer of endothelial cells and Descemets’ membrane

  • There is minimal disruption of ocular anatomy

  • A gas bubble containing 20% SF6 is injected into the eye to hold the corneal transplant in place. This gas bubble stays in the eye for 5 days. During this time, the patient will need to lay flat for most of the day.

  • lowest lifetime risk of graft rejection (~2%)

  • Patients have a very high quality of vision afterwards, many achieving vision of 20/25 or better

DSEK Procedure

  • Transplanted Cornea: 60-120 microns of corneal stroma, along with a layer of endothelial cells and Descemets’ membrane

  • Can be performed in patients with complex ocular anatomy (prior corneal transplant, history of glaucoma, prior trauma)

  • An air bubble is injected into the eye to hold the corneal transplant in place. This gas bubble staysi in the eye for 24-36 hours. During this time, the patient

  • Easier post-operative recovery experience

  • 2-8% lifetime risk of corneal graft rejection

  • Patients have a very good quality of vision afterwards, many achieving vision of 20/30 or better

 

Advantages of DMEK

  • Patients have a very high quality of vision afterwards, many achieving vision of 20/25 or better

  • No higher order aberrations. No distortions in vision.

  • Minimal disruption of ocular anatomy

  • lowest lifetime risk of graft rejection (~2%)

  • No increase in higher-order aberrations - patients have no distortions related to LASIK or multifocal lens implants.

Advantages of DSEK

  • Patients have a very good quality of vision afterwards, many achieving vision of 20/30 or better

  • Easier post-operative recovery experience (a patient only needs to lay flat for 24-36 hours)

  • Difference in quality of vision is minimal compared to DMEK.

Why do I have to lie flat after a DMEK or a DSEK Procedure?

During both DSAEK and DMEK surgery, the diseased innermost layer of the cornea is removed and replaced with a thin layer of tissue from a healthy donor cornea. The transplant is then held in place by only an air bubble. After surgery, patients are required to lie flat on their backs with their faces directed upwards immediately, so the transplant is able to float on top of the air bubble. For patients who have had DSAEK, the patient will have to lie flat on their back for 24-36 hours after surgery while the air bubble dissipates. For patients who have had DMEK surgery, the air bubble is mixed with SF6 (sulfur hexafluoride) gas, and the patient will have to lie flat on their back for 4-5 days after surgery.

Your doctor will discuss with you the options that will better suit your needs.

What is the recovery time after a DMEK or a DSEK Procedure?

Every patient recovers at a different pace. From an activity standpoint, recovery is usually about 5-7 days. Your doctor will typically ask you to refrain from any exercise or extensive physical activity during this time. It is typically 2-4 weeks before you are able to engage in strenuous exercise.

For many patients, during the first week after surgery their vision is typically quite poor in the operated eye. After surgery, it may take up to 3-6 weeks for your vision to recover. During this time, your vision is expected to fluctuate but will gradually improve.

What to expect after DMEK and DSEK Surgery

DMEK Surgery

How long will I have to lie flat after DMEK surgery?

This will depend on your surgeon's instructions, but it may typically range between 2-5 days.

When will I start to notice my vision improving after DMEK surgery?

Visual recovery usually takes about 1-2 months after DMEK or DSEK surgery. This is usually a gradual process, and during the first week after surgery, your vision may even be more blurry than it was prior to surgery.

How long before I can travel after DMEK surgery?

This will depend on your rate of recovery and your surgeon's instructions, though it is approximately 1 week. In general, while there is an air/gas bubble in your eye, you cannot partake in any air travel, though car/train travel is permissible. This is because with dramatic shifts in altitude, the air/gas bubble can expand and cause a dramatic increase in pressure in the eye, which may also cause pain, headaches, and blurry vision. Medically, this is a form of pupillary block, a type of angle-closure glaucoma. If this happens, a patient requires emergency medical attention. If not addressed in an expedient manner, it may lead to long-term or permanent eye problems.

DSEK Surgery

How long will I have to lie flat after DSEK surgery?

This will depend on your surgeon's instructions, but typically 24-36 hours.

When will I start to notice my vision improving after DSEK surgery?

Visual recovery usually takes about 1-2 months after DMEK or DSEK surgery. This is usually a gradual process, and during the first week after surgery, your vision may even be more blurry than it was prior to surgery.

How long before I can travel after DSEK surgery?

This will depend on your rate of recovery and your surgeon's instructions, though it is approximately 1 week. In general, while there is an air/gas bubble in your eye, you cannot partake in any air travel, though car/train travel is permissible. This is because with dramatic shifts in altitude, the air/gas bubble can expand and cause a dramatic increase in pressure in the eye, which may also cause pain, headaches, and blurry vision. Medically, this is a form of pupillary block, a type of angle-closure glaucoma. If this happens, a patient requires emergency medical attention. If not addressed in an expedient manner, it may lead to long-term or permanent eye problems.

Other FAQs with DMEK vs DSEK surgery

What is the advantage of DMEK surgery (compared to DSEK surgery)?

DMEK has been shown to offer patients the best chance to see 20/25 and resume their daily activities quickly. There is also a slightly lower long-term risk of graft rejection with DMEK compared to DSEK.

What is the advantage of DSEK surgery (compared to DMEK surgery)?

A patient has to lay flat for a shorter time after DSEK surgery, compared to DMEK surgery. This is because the thinner DMEK graft does not stick/adhere to the host cornea quite as well; a longer period of time is needed to ensure that the graft adheres well. With DSEK surgery, the chance of a graft detachment is also much lower.

When is DSEK preferred over DMEK?

Usually DSEK is preferred over DMEK surgery when a patient cannot lay flat long enough for DMEK, or has issues laying flat in general. Patients with neck, spine issues or back pain in general may benefit from DSEK surgery. Complicated EK surgery generally favors DSEK. Patients with other ocular conditions (a history of a prior corneal transplant, prior eye surgery/trauma, a history of glaucoma) typically benefit more from DSEK surgery

What kind of complications can occur with DSEK and DMEK surgery?

The main complication with DMEK and DSEK surgery, during the immediate post-op recovery period, is a graft being detached, or dislocated.

While an air/gas is in the eye, a patient may have angle-closure or pupillary block glaucoma, which may cause pain, headache, nausea and/or vomiting.

  • This is a post-surgical emergency; you need to call your surgeon immediately. While there is an air/gas bubble in the eye, if the air moves from the anterior chamber (front part of the eye) to the back part of the eye, this can cause angle closure or pupillary block glaucoma. If this happens, the eye will feel very firm/hard, and a patient may have pain, headache, nausea and/or vomiting. This may happen for any number of reasons, but bending forward and/or looking down often makes it worse, and more likely to cause problems. The best thing you can do is to sit upright, or lie flat, and call your ophthalmologist to coordinate the next steps. Your ophthalmologist may then need to release some of the pressure built up inside your eye.

  • This may happen in a small fraction of patients after DMEK or DSEK surgery. In general, this is more likely to happen in patients with DMEK surgery. If this happens, your ophthlamologist will inject a small amount of air into your eye and ask you to lie flat for another 24 hours.

  • This may happen in a small fraction of patients after DMEK or DSEK surgery. In general, this is more likely to happen in patients with DMEK surgery. If this happens, your ophthlamologist will need to reposition the graft, and then inject a small amount of air into your eye and ask you to lay flat for another 24 hours.

An eye exam is the best way to screen for, and evaluate any eye conditions affecting your health, comfort, and quality of vision.