Other Procedures

Dr. John Hovanesian of Harvard Eye Associates was the first surgeon in southern California to perform a new form of corneal transplant called Descemet's Stripping Endothelial Keratoplasty (DSEK). This procedure improves vision for patients with certain types of corneal diseases that cause clouding of the front, clear part of the eye (Fuchs Endothelial Dystrophy, Pseudophakic Bullous Keratopathy).

Below is a video of a broadcast about DSEK on WNDU, an NBC affiliate in Indiana in July, 2009.

Follow this link to download a Harvard Eye Associates interview covering DSEK

Comparison of Different Types of Corneal Transplant Procedures The cornea is the front clear part of the eye. Corneal clouding (edema) most frequently occurs because of loss of the "endothelial" cells that line the inside of the cornea. In this diagram of a healthy eye, these endothelial cells are shown as a blue line on the inside of the cornea. A cloudy, swollen cornea develops when there are too few endothelial cells. The black arrows show the area where an incision is made in a conventional corneal transplant.

Penetrating Keratoplasty (PKP), Conventional Corneal Transplant Surgery In conventional corneal transplant surgery (called penetrating keratoplasty), the surgeon removes the window of cloudy tissue from the patient's cornea and replaces it with donated tissue from a cadaver. This new tissue is held in place with many tiny stitches. To allow healing, these stitches must remain in place for at least six months. Then they are usually removed slowly over several office visits. During this time, vision is usually very poor, and the stitches may cause discomfort. Even after all stitches are removed, vision may not return to normal because of warping or 'irregular astigmatism' that remains in the corneal graft.

Descemet's Stripping Endothelial Keratoplasty (DSEK)
In DSEK, the surgeon uses special instruments to enter the eye through a less than 1/4 inch incision in the front clear part of the eye (cornea). The back portion of the cornea (Descemet�s membrane) is then painlessly stripped away and replaced by a similar piece of healthy graft tissue from a cadaver donor. Although only a small piece of cornea is actually replaced, the graft will help keep the entire cornea clear.

DSEK has several advantages over conventional transplant surgery.

• No stitches are placed in the cornea. In clinical studies, this has resulted in significantly less astigmatism after surgery and faster recovery of vision.
  
  
• In general, fewer follow-up exams are necessary because there are no corneal stitches to be removed. Ongoing studies are also examining whether corneal transplant rejection is less likely with DSEK than conventional transplants.

Like conventional transplantation, DSEK surgery is covered by most major insurance carriers, including Medicare. DSEK is not appropriate for all patients with corneal disease.

Schedule a consultation with our staff to learn more about DSEK.

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