DSEK corneal transplant

[wischeez]

Anyone else ever have this done, or going to get it done? Just had my left eye done on Tuesday the 28th and it's like looking through the bottom of a bottle out that eye.

Descemet's Stripping Endothelial Keratoplasty (DSEK)
Replacing only the innermost cornea layer

 

[RadiclDreamer]

Never heard of it, what exactly is it and why is it done, all the googling ive done is tl:dr

 

[wischeez]

The innermost layer (Descemet's membrane) of the cornea is stripped away and replaced with a donor layer. Mine was what they referred to as "diseased". It was swollen and not the right curved shape. It made everything out of focus and affected my depth perception.

 

[Teknic]

At least you didn't have to have a PKP for your keratoconus.

 

[wischeez]

At least you didn't have to have a PKP for your keratoconus.

Do you mean Penetrating Keratoplasty (PK)? Replacement of the entire cornea?

The only real difference in the two is what part of the cornea is replaced, whole thing, center section, or like mine, the rearmost layer. The recovery time is also longer for PK as opposed to DSEK. To do DSEK, they still have to make an incision in the eye to remove and replace the back layer.

 

[Viper GTS]

I've had two of the penetrating variety, they were not fun. The difference in quality of life is worth it, of course, but it's a serious pain in the ass.

What's the reason for the transplant? Mine was keratoconus.

Viper GTS

 

[wischeez]

Inner layer was swollen and clouded. Everything was blurry, and on humid days it was twice as bad. How long was your recovery? How long was it before your vision stared to get cleared up? I was told the vision would get better over about a month or so for mine.

 

[rcpratt]

I had the opposite for my keratoconus about two months ago. Replaced everything but the innermost layer.

Just now getting over the light sensitivity, although I'll always be sensitive, but that's nothing new.

My vision is terrible in the first place, so I still can't really see - but they can correct it to about 20/50 right now, but no glasses yet since it's going to keep changing.

 

[wischeez]

What are they doing to correct your vision right now? Before surgery, I was told I had 20/300 in the left eye and 20/40 in the right eye. Light sensitivity for me only lasted 2 days to the point it hurt to see the sun. Now I can look outside and it doesn't bother me..

 

[rcpratt]

They're not doing anything except checking it in the office right now. Only had the surgery on the right eye, left can still be corrected with contacts, although I'll have that one done someday.

I've been able to function since the third day, but there are some days when it's cloudy and I'm wearing sunglasses outside. It has felt real good for the past week though.

 

[wischeez]

How long ago was the surgery done? I don't do contacts, so I'm going to have to talk to the Doc next week and see what can be done to fix up the right eye so I can see from that eye at least. I was pretty much able to function since Wednesday. I had the surgery on Tuesday morning. Been off work since Tuesday.

 

[Viper GTS]

My first was October of 2005, second in January 2007. Within a month or two of the full PK I was relatively normal feeling. The steroid drops for months is annoying.

I'm still having fragments of suture removed years after the fact. I've only got a couple pieces left but every few months they pop through. That means a short notice trip to the eye institute, a little digging with a razor blade, and then a week of antibiotics and steroids. Rinse and repeat. I look forward to the day when they're able to get all of it out.

My vision is correctable with glasses to around 20/30 or 20/35 now. Legal to drive, but not great. It was better a year or two ago. I'm at a point now where I need to return to contacts to get better vision, but I hate them with a passion. Light sensitivity is a constant problem, I have prescription sunglasses for use in the car but I generally avoid the outdoors. Live music with pyro is almost impossible to watch, even movies in a theater can be a problem.

Viper GTS

 

[wischeez]

Compared to yours Viper GTS, mine sounds like a cake walk. I was told by the Doc that they put in a couple of stitches to keep the incision closed, but nothing like what you went through. I'm also on antibiotic and steroid drops. The antibiotics are for 1 week, and steroids for probably a month or so. Did your eyes constantly tear because of the stitches?

I'm a mechanic, so I'm in and out of the sun. As far as I can tell, the light sensitivity went away the day after surgery. I've been outside, and although it seems brighter, the light doesn't make my eye hurt anymore.

Your vision isn't too bad at 20/30. What was it before the surgery? My right eye is 20/40 without correction. The left was 20/300 without correction before surgery. I'd be happy with 20/30, even corrected!

 

[Viper GTS]

The sutures tend to end up embedded, eventually you won't feel them at all. Until they break, of course. For the first few months tearing is normal. For the first couple weeks after both surgeries I couldn't open my eye in the morning. Even after that goes away you'll still end up with tears randomly during the day for months.

Before the transplants I was only correctable to 20/100 in my "bad" eye. I had fairly severe scarring right in the middle of both corneas so no amount of glasses or contacts was ever going to fix it. The transplants made an immediate difference in clarity, & once fully healed I was initially correctable to nearly 20/20 with glasses alone. Things have shifted since then but 20/30 ish is still usable vision.

Viper GTS

 

[wischeez]

I really appreciate all the info Viper GTS. So far, like I said earlier, it's pretty blurry out of that eye. I was told it will take some time before the vision clears up. I can make out the picture frame shape, but not the picture. I've read some stories from other people that said their vision the day after surgery was 20/40 or better. I sure hope mine comes out that good given some time.

For the first couple days the eye wouldn't open in the morning, but now I'm able to get it open on it's own without using warm water and Kleenex.

 

[Teknic]

Do you mean Penetrating Keratoplasty (PK)? Replacement of the entire cornea?

The only real difference in the two is what part of the cornea is replaced, whole thing, center section, or like mine, the rearmost layer. The recovery time is also longer for PK as opposed to DSEK. To do DSEK, they still have to make an incision in the eye to remove and replace the back layer.

Yeah, a penetrating keratoplasty. However there's a big difference between DSEK and a PKP. Just ask Viper GTS.

The reason you are light sensitive after surgery is due to inflammation; that resolves over time while you take pred forte/lotemax/whatever they gave you. Do you have Fuch's? Visual acuity may improve up to 12 months following DSEK, so don't expect instant results.

Viper GTS: You may need to look into rigid contact lenses -- you should see an optometrist that specializes in keratoconus or post surgical cornea patients. Especially if you have lots of astigmatism.

 

[wischeez]

Yup, Fuch's. I know it tales some time for vision to return, so I'm not expecting results after only 5 days. My light sensitivity pretty much went away the second day.

Pred forte and Polymyxin B Sulfate

 

[Teknic]

Make sure you shake the pred forte since it's a suspension not a solution. Corneal edema will last a few months, and that will produce symptoms such as glare and halos. At least with DSEK that leaves most of the cornea intact, so it produces a lot less problems than a full thickness corneal transplant.

Your pre-op visual acuity was 20/300...was that best corrected (with glasses/contacts)? 20/300 is an strange number because most charts go from 20/400 - 20/200 (skipping 20/300).

Fuch's Endothelial Dystrophy results in corneal edema producing vision/pain issues if it progresses. Therefore to reduce the symptoms, you have to decrease the swelling by dehydrating the cornea. Sodium Chloride 5% drops, or Muro-128 may help for your right eye. I have heard of people using a blowdryer to produce the same effect, but obviously be careful.