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Descemet's stripping endothelial keratoplasty (DSEK) is a procedure that involves replacing only the innermost layer of the cornea, rather than the entire thickness of the cornea, as is performed in standard full-thickness corneal transplantation. For patients who have conditions such as Fuchs corneal dystrophy or swelling of the cornea after cataract surgery, corneal clouding is caused by dysfunction of the cells that make up the innermost layer of the cornea, called the corneal endothelium. The corneal endothelial cells function to pump fluid out of the cornea. When these cells are damaged or reduced in number, the cornea swells, resulting in corneal clouding and loss of vision. Even though the other layers of the cornea are healthy, this condition has traditionally been treated with full-thickness corneal transplantation to bring a new layer of endothelial cells to the patient's eye.
DSEK surgery involves peeling only the diseased endothelial layer from the back of the patient's cornea, leaving the remaining 95% of the cornea, which is healthy, untouched. The posterior layer of a healthy donor cornea is then placed inside the eye through a small incision and positioned with an air bubble to replace the diseased layer that was removed. DSEK is performed in less than one hour without any sutures in the cornea.