DSEK surgery (also known as Descemets Stripping Endothelial Keratoplasty) was the first generation of layered corneal transplantation surgery to replace the failing inner cells of the cornea. This procedure was an extension of DALK surgery, where the front layer of the cornea is partially replaced. Although the procedure is designed to replace the vital cells of the cornea (shown in red), it also replaces the thick corneal tissue as well (shown in blue in the diagram).
The natural cornea is shown in the diagram in green, and the donated human corneal tissue in blue, with the transplanted vital cells shown by the dotted red line. DSEK surgery results in a thicker cornea, which may influence the final visual outcome. See Compare Transplants for further explanation.
DSEK vs DSAEK
As occurs with the first generation of any new technique or device, DSEK was associated with it's own set of complications including scarring and haze, which may interfere with vision. The results of initial DSEK surgery also showed higher failure rates, which is believed to be due to technical reasons associated with surgery. DSEK evolved into DSAEK, with the "A" referring to Automated, where a machine cuts the corneal tissue. This can result in variable thickness or variable sized donor tissue. DSAEK is very popular in the USA.
Further improvements in vision have been achieved with the evolution of the fourth generation of endothelial transplantation called DMEK or Endothelial transplantation, where transplantation is limited to the specific cell layer and it's supporting structure. DMEK has been pioneered in Europe, whilst the USA has persisted with DSAEK. Dr Anthony Maloof no longer performs or recommends DSEK, and most of Dr Maloofs patients who had previous DSEK surgery have since been changed to DMEK or Endothelial Transplantation.