In addition, the surgery is safer as the new cornea is inserted through a small incision rather than a complete opening of the front part of the eye reducing the chance of a devastating hemorrhage during the surgery or infection afterwards. Because a smaller incision is used, the eye is left stronger so that if it is inadvertently struck there is less likelihood of a serious injury.
The main disadvantage of the DSAEK procedure is that the new endothelium is manipulated more directly than in a full thickness corneal transplantation, potentially producing more damage and possibly resulting in graft failure. There is a 10% chance that the new tissue will not adhere properly requiring repositioning, or in less than 1% of cases, re-operation. The long-term survival of this tissue has not been fully studied. The cornea is also left much thicker than the original due to the addition of tissue to the posterior aspect of your current cornea. This may make it more difficult to follow glaucoma.
In order to make the new tissue stick onto the back of the old cornea, an air bubble is used to completely fill the front part of the eye for an hour after surgery. After that time the air is partially released and left overnight. During the first twenty-four hours, it is important to stay on your back as much as possible to keep the air bubble positioned correctly, anchoring the new tissue in place. When you are seen the next day, the position of the new tissue will be checked. It may be necessary at that appointment or the next appointment one week later to reposition the new tissue by placing a new air bubble. Once the tissue sticks, it remains in place, so the most critical post-operative period is the first six weeks.