DMEK and DSAEK are both advanced surgeries for Fuchs’ dystrophy and other causes of corneal endothelial failure, during which a very thin layer of new cells is placed inside the eye. The new cell layer is held in place by an air/gas bubble that supports the new layer and gradually disappears over 3-5 days. Unlike a full thickness corneal transplant, very few stitches are used in DMEK/DSAEK surgery and visual recovery is more rapid. Rejection rates are also lower after these surgeries.
It is important to know what to expect in the post-operative period after DMEK/DSAEK so as not to feel worried or anxious as you recover.
What to expect in the first 5 days after DMEK/DSAEK surgery
The front chamber of the eye will be filled with gas/air and hence vision will be impaired. It is not possible to see through an air bubble in the eye. Vision will typically be worse than before the surgery. You will be able to see light and blurred shapes. You will not be able to read with the operated eye.
As the air bubble absorbs and disappears, it will move upwards (air floats on water), and one may be able to see the meniscus of the bubble as a dark curved line in your vision. The bubble can be seen externally if you look at the eye in the mirror. Once the air is above the level of the pupil, vision will begin to return.
The air bubble will typically disappear completely 5-7 days after surgery. If you have had a vitrectomy in the past there can also be air that travels to the back of the eye and you may then see two bubbles. This will also disappear.
Some irritation, grittiness or aching of the eye is normal after DMEK/DSAEK. Severe pain is unusual. The eye can also feel itchy. It is important not to rub or touch the eye. Follow the instruction you were given regarding medication.
Further air injection after DMEK/DSAEK
Your surgeon will typically review your eye 3-5 days after surgery. At this stage, if there is any part of the graft that is not attached the surgeon may choose to inject further air into the eye. This is painless, and you will simply feel a pressure feeling whilst this is being done. The air will take 5-7 days to completely disappear.
Stitches are usually removed in the clinic a few weeks after surgery. In some cases a contact lens is placed on the eye at the time of surgery for comfort and this is removed a week later. If the lens falls out, don’t worry.
How long does it take for vision to recover after DMEK/DSAEK?
Visual recovery after DMEK/DSAEK takes 1-4 weeks. Typically vision is poor in the first few days due to the air bubble. Vision begins to improve once the bubble is above the level of the pupil. Good vision can be expected a month after surgery. New glasses can typically be measured 6 weeks after surgery.
What eye drops are used after DMEK/DSAEK surgery?
You will need to use an anti-inflammatory steroid (dexamethasone) and antibiotic drops (moxifloxicin or chloramphenicol) after surgery. In some cases you may be asked to use sodium chloride drops (salt drops) to aid corneal clearance.
Our regime of eye drops after DMEK/DSAEK is as follows;
Week 1 - Dexamethasone (Dexafree/Dropdex) 1 drop every 2 hours (not overnight), Moxifloxicin 1 drop every 2 hours (not overnight)
Week 2- Dexamethasone (Maxidex) 4 times a day (not overnight), Moxifloxicin 4 times a day (not overnight)
Weeks 3-4 - Dexamethasone (Maxidex) 4 times a day - continue until seen by your surgeon.
Dexamethasone continues long term and will be gradually tapered to once a day. This prevents cell rejection.
What should you watch out for after DMEK/DSAEK surgery?
Some discomfort is expected after surgery. However, if you experience severe pressure like pain in the 24 hours after your surgery you should contact your doctor or the hospital. If this is accompanied by loss of perception of light (everything is dark and you can't see light shone on the eye) you should seek urgent attention as this can be an indication of dangerously raised pressure in the eye. The walk-in eye emergency clinic is open at Moorfields 24 hours a day every day of the year and you will be seen at any time if you are worried.
Generally your eye should feel more and more comfortable with time after the surgery. If your eye suddenly becomes red, painful or starts to have a sticky discharge after a period of getting better (in other word it suddenly gets worse), you should contact your doctor. This can be a sign of infection which is rare.
Allergies can rarely occur with routine eye drops. If your eye or skin surrounding the eye become red and itchy after surgery let your doctor know