Purpose of review: Descemet's stripping endothelial keratoplasty (DSEK) is rapidly becoming the preferred treatment for corneal endothelial dysfunction. Familiarity with recent advances in techniques and instrumentation can help reduce the initially steep learning curve and incidence of complications.
Recent findings: DSEK produces excellent visual outcomes with minimal change in corneal surface topography or refraction. It can successfully treat corneal dysfunction associated with Fuchs' endothelial dystrophy, bullous keratopathy, iridocorneal endothelial syndrome or a failed penetrating graft. Donor dissection has become automated, and new techniques have been devised to facilitate graft insertion and unfolding. Some surgeons now routinely perform DSEK with topical anesthesia. Graft detachment is the most frequent early postoperative complication, but new methods can help promote donor adherence. The incidence of graft-rejection episodes is lower after DSEK compared with standard penetrating keratoplasty, possibly because wound healing is a lesser concern, and many DSEK patients are maintained on low-dose topical steroids indefinitely. Early efforts to transplant just the endothelial cell layer show promise.
Summary: DSEK provides quicker visual rehabilitation and an improved safety profile compared with standard penetrating keratoplasty. Continued evolution of this relatively new technique is helping to reduce complications and further improve outcomes.