DSAEK may become procedure of choice for endothelial disease

The Descemet's stripping automated endothelial keratoplasty (DSAEK) procedure is a safer, more predictable approach to endothelial disease than penetrating keratoplasty and ideally suited for patients with Fuchs' dystrophy, pseudophakic bullous keratopathy, or failed corneal grafts, explained Mark S. Gorovoy, MD, who pioneered this technique.

The goal of the DSAEK procedure is to focus on replacing only the diseased Descemet and endothelial complex with an automated dissection. He described the step-by-step procedure for the donor cornea preparation, patient preparation, and donor tissue insertion and positioning during a symposium sponsored by Moria.

A donor cornea is placed onto the Moria ALTK Artificial Anterior Chamber. Then using a 300-micron head on the Moria CBm Microkeratome, an anterior lamellar cap is removed. The remaining posterior portion of the donor cornea is transferred to a punch block for trephination. The patient is marked prior to Descemet's scoring and stripping. After Descemet's removal, the donor cornea is covered with Healon (Advanced Medical Optics) before folding and insertion. The I/A instrument is used to unfold the tissue graft and center it. Then an anterior chamber air bubble is injected to press the tissue up against the patient's cornea. After 1 hour, Dr. Gorovoy will release the air bubble to avoid pupillary block.

The results of DSAEK are impressive with 84% of patients achieving a best-corrected visual acuity (BCVA) of 20/40 by 4 to 6 weeks postoperatively. Dr. Gorovoy reported on a study of his first 350 cases. In this patient cohort, 91% achieved this level of visual acuity by 3 months postop and 15% had 20/20 BCVA, he noted.

"No variation of PK will give these functional results," Dr. Gorovoy concluded.

Other speakers covered the refractive results of the combined procedure of DSAEK with cataract extraction and IOL implantation, DSAEK surgical pearls for the converting corneal surgeon, Descemet's stripping endothelial keratoplasty in more than 450 consecutive cases, ALTK and DSAEK in two patients with one cornea, and perspectives on DSAEK surgeries.