Dr. Steven Koenig uses DSAEK (Descernet's Stripping and Automated Endothelial Keratoplasty) a form of small incision partial thickness corneal transplantation to treat many forms of corneal edema, including swelling due to Fuchs' corneal dystrophy as well as unresolved swelling after cataract surgery. Dr. Koenig has years of experience performing DSAEK at the Medical College of Wisconsin. Dr. Koenig is among a handful of corneal surgeons who helped pioneer these procedures early on. The result of his clinical studies on DSAEK for Fuchs' endothelial dystrophy performed at the Medical College of Wisconsin in Milwaukee have been published in Ophthalmology, the American Journal of Ophthalmology as well as the journal Cornea. He has treated patients from all over the United States suffering from a variety of corneal conditions including Fuchs' corneal endothelial dystrophy, pseudophakic bullous keratopathy, and ICE Syndrome.
Descemetís Stripping and Automated Endothelial Keratoplasty (DSAEK) is a relatively new surgical procedure that has been performed at the Eye Institute for the past six years. A conventional corneal transplant, in which the entire thickness of the patient's cornea is typically replaced with a similar donor corneal button, requires 16 sutures and a prolonged recovery time with many patients experiencing significant post-operative astigmatism after transplantation. In contrast, DSAEK is typically performed through a tiny incision that is usually closed with a single suture. The diseased back layer of the patient's cornea is replaced with healthy new corneal endothelial cells attached to a thin layer of donor corneal tissue. Once the donor corneal tissue adheres to the back of the patient's cornea, it begins to remove excess water from the swollen cornea. The procedure leads to a rapid recovery of visual acuity with no associated astigmatism and very few of the problems associated with standard corneal transplantation. It represents the most significant advance in corneal transplantation in the last 100 years and has revolutionized our approach to managing patients with corneal edema from a variety of causes.
DMEK stand for Descemet's Membrane Endothelial Keratoplasty and represents the most advanced form of endothelial replacement surgery. In this procedure, the diseased back layer of the cornea called Descemet's membrane and endothelium is removed and replaced with a single cell layer donor cornea containing healthy endothelial (pump cells) and Descemet's membrane. The technique offers the potential for rapid visual rehabilitation, better visual acuity and lower graft rejection rates than other forms of endothelial transplantation. The Eye Institute is one of only a handful of centers around the country that offer this most advanced form of corneal transplantation.
Fuchs' Dystrophy is a progressive corneal disorder characterized by gradual deterioration of the corneal endothelium. The endothelium is responsible for controlling fluid and solute transport into and out of the cornea in order to maintain the clean and slightly dehydrated state necessary for clear vision. In patients suffering from Fuchs' Dystrophy, the endothelium gradually loses its ability to regulate fluid and solute transport. As impurities build up in the cornea and hydration levels fluctuate, the cornea swells and vision becomes blurry. Occasionally blisters form on the endothelium, which can be very painful. With time, Fuchs' Dystrophy patients can become functionally blind. At that point, a corneal transplant is generally recommended.
Treating Fuchs' dystrophy with DMEK or DSAEK corneal transplant surgery is a new frontier in ophthalmology. Steven Koenig, M.D., is a recognized expert on medical conditions affecting the cornea. To learn more or to schedule a consultation, please call (414) 955-2020, #2.
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