In 1998, Dutch ophthalmologist Gerrit Melles, MD described a technique in which the inside layers of the cornea were manually dissected and selectively replaced (Melles et al, 1998). In 2001, Mark Terry, MD described a modified technique in which the dissection was performed with viscoelastic and termed his technique deep lamellar endothelial keratoplasty, or DLEK (Terry & Ousley 2001). The manual dissection is tedious and involves a steep learning curve. Dr. Melles has since developed a technique that involves stripping of Descemet’s membrane instead of a lamellar dissection, which has been termed Descemet’s stripping endothelial keratoplasty, or DSEK (Melles et al, 2004).
- Less postoperative astigmatism
- Faster visual recovery
- Stronger wound integrity
- Less risk of rejection since less tissue replaced
DSEK is useful in patients with varying types of endothelial dysfunction, including Fuchs dystrophy, Pseudophakic bullous keratopathy (PBK), Aphakic bullous keratopathy (ABK), and Posterior Polymorphous dystrophy (PPMD) (Melles et al, 1998, Terry & Ousley 2001). Recent modifications to this surgery include the use of "ultra-thin" grafts (ultra-thin DSEK) and transplanting only Descemet's membrane (DMEK). These newer techniques seem to offer better visual outcomes and are used in our patients who are appropriate candidates.