DSAEK — Endothelial Corneal Transplant

The endothelium and why it fails

The corneal endothelium is a single layer of cells on the cornea's inner surface that continuously pumps fluid out, keeping the cornea clear. These cells do not regenerate. When their number or function falls below a threshold — through Fuchs endothelial dystrophy, surgical injury, inflammation or previous graft failure — the cornea swells, and vision becomes hazy with glare and, in advanced cases, painful surface blisters (bullae).

What DSAEK does

Descemet Stripping Automated Endothelial Keratoplasty removes the patient's diseased Descemet's membrane and endothelium and replaces them with a thin disc of donor tissue carrying healthy endothelial cells. The graft is inserted through a small incision and held against the back of the cornea with an air or gas bubble — no large wound and typically no surface sutures.

Who may be considered

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• Fuchs endothelial corneal dystrophy with visually significant swelling
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• Bullous keratopathy (corneal swelling after previous intraocular surgery)
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• Failed previous graft with endothelial failure, in selected cases
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Benefits compared with full-thickness transplant

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• Small-incision surgery; the eye's structural strength is preserved
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• Much faster visual recovery — often weeks rather than many months
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• Minimal induced astigmatism; stable refraction
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• Surface of the cornea is untouched
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Limitations and risks

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• Graft detachment in the early days — may need a repeat air/gas injection (rebubbling)
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• Endothelial rejection remains possible (though less frequent than with PK); RSVP warning symptoms apply
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• Gradual donor cell loss over time; a minority of grafts eventually fail and can be repeated
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• Rise in eye pressure (pupillary block or steroid response) — monitored at reviews
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Recovery and positioning

After surgery the air bubble must press the graft into place; your team will give specific posturing instructions for the first day or two — follow them exactly as directed for your own eye rather than generic advice. Vision typically clears progressively over days to weeks as the swelling resolves. Drops are tapered over months and reviews continue long-term.

Information on this page is for general education and does not replace an examination, diagnosis or personalised medical advice from a qualified eye-care professional.

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