Improved Cornea Surgery Technique Enhances Transplant Success

A modified ophthalmologic surgical technique significantly improves results in patients being treated for endothelial disease of the cornea, according to a new study.

Researchers at the Villa Serena Hospital (Forli, Italy) developed a modified descemet-stripping automated endothelial keratoplasy (DSAEK) technique that resulted in rates of donor endothelial cells survival equivalent to the standard surgical approach, penetrating keratoplasy (PK, otherwise known as complete cornea transplantation). The modified technique was developed in response to a significant drawback of the standard DSAEK procedure, which results in limited survival of the transplanted endothelium, with a reduction of up to 50 % of preoperative density as early as six months after surgery. The study was presented at the annual meeting of the American Academy of Ophthalmology, held during November 2007 in New Orleans (LA, USA).

"Our approach reduced the rate of endothelial cell loss in the transplanted tissue to an average of 23% at one year post-surgery, which is similar to values recorded after PK,” said lead author professor of ophthalmology Massimo Busin, M.D. "Our 'pull through' technique simplifies the DSAEK procedure and, more importantly, resolves the main obstacle that has delayed corneal surgeons' transition to DSAEK.”

In DSAEK, the diseased Descemet's membrane is removed, attached to a thin layer of deep stroma, and the normal structure of the recipient cornea is not disrupted, leaving the eye much stronger and less prone to injury than full-thickness transplants. DSAEK uses only a small incision that is either self-sealing or may be closed with a few sutures. Because the procedure is less invasive, vision is typically restored in one to three months rather than one to two years in PK, and the risk of complications during and after surgery is minimized.


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