DLEK and DSAEK Corneal Replacement: On the Cutting Edge of Vision Correction
In the last 20 years, ophthalmologists have developed a new arsenal of exciting, cutting-edge techniques to treat an ever-widening array of medical problems of the eye. Laser vision correction has become one of the fastest-growing disciplines in medicine, and as baby boomers continue to age, demand for vision correction procedures of all kinds should continue to swell. This creates both the incentive and the resource base needed to explore more new surgeries and further refine existing techniques. As the advent of custom LASIK demonstrated, there is ample room for improvement with even the most popular procedures.
In keeping with this trend, two exciting new corneal transplant procedures have recently been made available to the public. These procedures are called deep lamellar endothelial keratoplasty (DLEK) and Descemet's stripping and automated endothelial keratoplasty (DSAEK). Together, they show the potential to change the lives of millions suffering from diseases and injuries of the cornea, including Fuchs' Dystrophy and corneal edema. DLEK was first conceived by American ophthalmologist Mark Terry, while DSAEK was the brainchild of Dutch ophthalmologist Gerrit Melles.
While DLEK and DSAEK are relatively new, the immediate results are encouraging. In comparison to patients undergoing penetrating keratoplasty (PKP), long considered the benchmark corneal transplant procedure, DLEK and DSAEK patients show fewer complications, heal more quickly, and experience significantly better visual acuity. Because results for DLEK were first published in 2001, and for DSAEK in 2004, long-term results for the procedures are not yet known.
The unique advantage of DLEK and DSAEK is that they replace only a small portion of the cornea, known as the endothelium. This layer of cells is responsible for regulating fluid transfer into and out of the cornea, a process with strong implications for visual acuity. Because DLEK and DSAEK replace only a single layer of cells on the back of the cornea, they are significantly less invasive and less risky that traditional corneal replacement techniques such as PKP.
Both DLEK and DSAEK require only a small incision in the sclera, or white tissue, of the eye – in most cases, no stitches are needed. This is important because PKP, which requires a larger incision, can take a year or more to heal. Additionally, a smaller incision is accompanied by reduced risk of complications during healing. Astigmatism is a common complication with large, multi-stitch incisions in the eye, but with DLEK and DSAEK, the likelihood of developing astigmatism during the healing process is greatly reduced.
Because both DLEK and DSAEK are so new, very few doctors in the U.S. are qualified to perform them. However, as with LASIK and other revolutionary surgical techniques, demand and availability are both sure to grow. Expect DLEK and DSAEK to be mentioned together with LASIK, CK®, PRK, and other yet-to-be named surgeries of the eye, and expect it sooner rather than later.
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