In Fuchs Endothelial Dystrophy, when is DSAEK considered?

• A. If severe
• B. If mild
• C. In all cases
• D. Never

Answer: (A)

The key idea is that Descemet Stripping Automated Endothelial Keratoplasty (DSAEK) is chosen when Fuchs endothelial dystrophy has progressed to a level of severe endothelial failure with persistent corneal edema and vision loss. In the mild stage, management is typically conservative—observation and medical therapy (like hypertonic saline drops and anti-inflammatory treatment) to control edema. As the disease becomes severe and symptoms impact function or quality of life, replacing the diseased endothelium with donor tissue via DSAEK restores corneal clarity and improves vision. It’s not indicated for mild disease, not automatically done in every case, and not avoided entirely; the decision hinges on the presence of significant endothelial decompensation.