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OUTLOOK EYE TREATMENTS

Endothelial Keratoplasty

What is a Corneal Endothelial Transplant?

A corneal endothelial transplant, also known as a Descemet’s Stripping Endothelial Keratoplasty (DSEK) or Descemet’s Membrane Endothelial Keratoplasty (DMEK), is a surgical procedure to replace a damaged inner lining of the cornea (endothelium).

Why is a Corneal Endothelial Transplant Needed?

The corneal endothelium is responsible for maintaining the transparency and clarity of the cornea by regulating its hydration levels. Damage to the corneal endothelium can result from factors such as Fuch’s endothelial dystrophy, corneal oedema, previous eye surgeries or trauma.

When the endothelial layer is damaged, the cornea may become swollen. leading to blurred vision, glare, and decreased visual acuity. A corneal endothelial transplant is performed to restore the normal functioning of the endothelium and improve vision.

The Transplant Procedure

Where required, the damaged endothelial layer is removed from the eye. Then a thin layer of healthy endothelial tissue from a donor cornea will be placed and secured in position using an air bubble.

After the surgery, you will be monitored for 1-2 hours to ensure stability. Eye drops will be prescribed to aid in healing and prevent infection. An eye patch or protective shield is worn overnight on the day of surgery.

Recovery and Expectations

Posturing: The transplant is held in place by an air bubble placed inside your eye. For this to be effective you will be asked to lie flat on your back the night after surgery and then for a further 1 to 3 days if required. 1 out of 5 people may need the air bubble re- inserted in the clinic to help attach the transplant.

Visual Recovery: Vision improvement after corneal endothelial transplant is usually gradual. Initially, your vision may be blurry or hazy, but it will improve over time as the cornea heals and the new endothelial cells settle into place.

Long-Term Care: After the transplant, regular follow-up visits will be necessary to monitor your progress, remove sutures if used, and adjust medications.

Potential Risks and Complications

Corneal endothelial transplants are typically much safer than full corneal transplants but it is important to be aware of potential risks and complications. These include infection, rejection of the transplanted tissue, increased eye pressure (glaucoma), swelling or detachment of the donor tissue, transient or persistent blurry vision and cataract formation.

Remember, the risks vary depending on individual circumstances, and I will discuss these with you in detail before the procedure.

A corneal endothelial transplant is a remarkable surgical procedure that can restore vision and improve your quality of life. Dr Brett Drury is a corneal specialist who performs all types of corneal transplants at Outlook Eye Specialists.

Frequently Asked Questions

Endothelial keratoplasty is a type of partial-thickness corneal transplant that selectively replaces only the innermost layer of the cornea, specifically the endothelium and Descemet’s membrane. The two main techniques are DMEK (Descemet Membrane Endothelial Keratoplasty) and DSEK (Descemet Stripping Endothelial Keratoplasty). Both offer faster recovery and better visual outcomes than traditional full-thickness corneal transplants.
DMEK transplants just the Descemet’s membrane and endothelial cell layer, an extremely thin tissue scroll approximately 10–15 microns thick. DSEK transplants a slightly thicker disc of tissue that includes a small amount of posterior stroma as well. DMEK achieves superior visual outcomes in most patients and has a lower rejection rate, but is technically more demanding to perform and has a slightly higher rate of requiring a rebubbling procedure.
Endothelial keratoplasty is the treatment of choice for Fuchs endothelial corneal dystrophy, a genetic condition that progressively damages the corneal endothelium. It is also used for bullous keratopathy (corneal oedema following prior intraocular surgery) and other causes of endothelial failure.
A thin scroll of donor Descemet’s membrane and endothelium is introduced through a small incision into the anterior chamber of the eye. The graft is unfolded using gentle fluid manipulation and positioned against the recipient’s posterior corneal surface. An air bubble injected into the anterior chamber holds the graft in place while it adheres, a process that takes approximately 1 hour.
Rebubbling refers to a procedure where an air bubble is re-injected into the anterior chamber to push the graft back into contact with the recipient cornea if it has partially detached. It is required in approximately 5–10% of DMEK cases and is performed in the clinic under topical anaesthetic. It does not adversely affect the final visual outcome in most cases.
After DMEK, patients are asked to maintain face-up (supine) positioning for as much as possible in the first 24–48 hours to keep the air bubble pressing the graft into position. The air bubble absorbs naturally over 3–5 days. Brief upright positions for meals and bathroom visits are permissible. Compliance with positioning significantly reduces the risk of graft detachment.
Most patients notice a significant improvement in vision within 2–6 weeks of DMEK as the corneal oedema resolves and the graft functions. Full visual recovery typically takes 3–6 months. The majority of patients achieve vision of 6/6 or better after DMEK for Fuchs dystrophy.
DMEK generally achieves better visual outcomes than DSEK, with more patients reaching 6/6 or better vision and faster recovery of contrast sensitivity. The rejection rate is also lower with DMEK. However, DSEK remains the preferred approach in certain cases, for example eyes with complex anatomy or prior vitrectomy, where DMEK would be technically very challenging.
The rejection rate is significantly lower for endothelial keratoplasty than for full-thickness penetrating keratoplasty. DMEK has the lowest rejection rate of any corneal transplant technique, at approximately 1% per year. DSEK rejection rates are somewhat higher but still considerably lower than PK. Long-term steroid drops are prescribed to minimise rejection risk.
Yes. Endothelial keratoplasty attracts a Medicare rebate for the surgical procedure and the ophthalmologist’s fee. Hospital and anaesthetic fees apply. Our team will provide a full cost breakdown at your pre-operative consultation.