Corneal Procedures

What is a Corneal Transplant?

A cornea transplant is a surgical procedure to replace part of your cornea with corneal tissue from a donor. A cornea transplant has the potential to restore vision, reduce pain and improve the appearance of a damaged or diseased cornea. There are three corneal procedures that fall under the category of a corneal transplant: DSAEK, DMEK and penetrating keratoplasty.

Conditions That Can Be Treated With a Cornea Transplant:

  • Corneal ulcers, including those caused by infection
  • Complications caused by previous eye surgery
  • Corneal dystrophies such as Fuchs’ dystrophy
  • Cornea scarring, caused by infection or injury
  • A cornea that bulges outward (keratoconus)
  • Clouding of the cornea
  • Thinning of the cornea
  • Swelling of the cornea


Corneal endothelial transplantation has become the gold standard for the treatment of corneal endothelial dysfunctions (such as Fuchs’ Dystrophy), which is far superior to replacing full-thickness cornea, known as penetrating keratoplasty.

Corneal endothelial transplantation has been described using two different techniques: Descemet’s membrane endothelial keratoplasty (DMEK) and Descemet’s stripping automated endothelial keratoplasty (DSAEK).

DMEK is more selective than DSAEK. Both DMEK and DSAEK remove Descemet’s
membrane and endothelium. DMEK adds only a new Descemet’s membrane and
endothelium. DSAEK also adds a new Descemet’s membrane and endothelium but with a layer of donor stroma. A way to remember this is to pretend that the “S” in DSAEK stands for “stroma.”

The difference between DMEK and DSAEK can be explained with a wallpaper
analogy. Let’s say your wall needs new wallpaper. In both DMEK and DSAEK, the old
wallpaper is removed. With DMEK, only new wallpaper is inserted. With DSAEK, a new piece of drywall that has new wallpaper on it is inserted on top of the old drywall.

Who Benefits from DSAEK/DMEK?

A very common cause of a cloudy cornea is damaged inside, or the endothelial layer of the cornea. The endothelial layer is one cell layer thick and can be damaged by surgery, trauma or the cells can degenerate over time as in a condition known as Fuch’s Dystrophy. When there are not enough endothelial cells, water can build in the cornea causing cloudy vision and vision loss.

DSAEK or DMEK are both highly-refined techniques that replace just the endothelial layer of the cornea, allowing surgeons to target the specific cause of the patient’s vision loss. The DSAEK/DMEK procedure allows damaged cells to be stripped from the patient’s cornea and replaced with a very thin back portion of a donor cornea.

This procedure allows your surgeon to target and replace only the damaged area of cornea, allowing a more precise treatment and better overall results. Dr. Smith uses an air bubble technique to hold the new tissue in place in the eye for several days after surgery until the graft becomes part of the cornea. No sutures are needed to hold the graft in place.

Fuchs’ Dystrophy patients are the primary group of patients needing a DSAEK/DMEK procedure. Fuchs’ endothelial dystrophy (FED) is a degenerative disorder of the corneal endothelium leading to corneal edema and loss of vision.

Advantages of DSAEK & DMEK Compared to Standard Corneal Transplantation

  • The eye surface is kept intact, thus remaining more resistant to injury and infection
  • There is minimal change in refraction because only the endothelial layer (~5% of the
    cornea) is replaced
  • Suture-related problems are significantly reduced/can be eliminated
  • Visual recovery is significantly faster and better

Penetrating Keratoplasty

A conventional full-thickness corneal transplant (penetrating keratoplasty) involves the surgical removal of the diseased or scarred cornea and replacement with clear, healthy donor tissue, which is held in place by sutures.

Visual recovery often takes a year or longer. Sometimes the corneal surface is somewhat irregular so a contact lens may be eventually required for the clearest vision.

Most cornea transplant procedures are successful. But cornea transplant carries a small risk of complications, such as rejection of the donor cornea. Due to the success of the DSAEK/DMEK procedures, penetrating keratoplasty is not often performed and is reserved for more serious corneal cases.

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Schedule a Corneal Evaluation

New Braunfels Vision Clinic is your local solution for exceptional vision care. Schedule a corneal evaluation and discuss our various procedures today.