When DMEK isn't right · sub-specialty technique

DSAEK in Cairo: the safer alternative when DMEK isn't possible.

DSAEK (Descemet Stripping Automated Endothelial Keratoplasty) is the right choice when the eye's anterior segment is too complex for DMEK, for example after prior glaucoma tubes, a very shallow chamber, or aniridia. It transplants a thin layer of stroma along with the endothelium, which makes it easier to handle in complex eyes. From $3,500.

Watch on AAOSmart Splash (DALK)Graft Exchange after DALK

DSAEK Endothelial Transplantation with Dr. Ahmed Shaarawy, Shaarawy Cornea Clinic

Why choose us

International standard. Regional access.

Devers Eye Institute fellowship

Trained directly under Prof. Mark A. Terry, one of the original developers of DSAEK. Same technique, same protocols.

When DMEK isn't safe, DSAEK is

DSAEK is forgiving. The thicker tissue makes it the right choice for complex eyes, prior glaucoma tubes, very shallow anterior chambers, aniridia, infant cases.

Faster than full corneal transplant

DSAEK preserves the front surface of the cornea, no full-thickness incision, no sutures across the whole graft. Visual recovery is much faster than PKP.

Internationally sourced tissue

Donor tissue imported from VisionGift, Saving Sight (USA), or European eye banks. Full chain-of-custody documentation, ≤48h sourcing.

Letter of recommendation

In Prof. Mark Terry's own words

Excerpts from the letter Prof. Mark A. Terry, Director of Corneal Services at the Devers Eye Institute, wrote for Dr. Shaarawy on 25 January 2015, at the end of his time in Portland.

In surgery, Ahmed assisted me in complex cataracts, anterior segment reconstructions, ocular surface reconstructions, and all forms of corneal transplantation including DMEK, DSAEK, DALK and PK. I often relied upon his observations during surgery and his objective advice when we got into difficult situations on complex cases. I have no doubt that he will deliver the kind of surgical care that will be the envy of his peers when he returns to Egypt.

In his research efforts for his thesis on relaxing incisions in DALK and PK patients, Ahmed was thoughtful and thorough and his insights have advanced the field. He initiated multiple experiments in the laboratory looking at endothelial damage from the iris and the IOL that can occur in DSAEK and DMEK surgery. In addition, he demonstrated amazing ingenuity in his laboratory experiments with alternate ways to unscroll the DMEK graft in the anterior chamber, a key stumbling block for many novice DMEK surgeons.

Legacy Health letterhead: Letter of Recommendation, Ahmed Mohammad Alshaarawy

In summary: Dr. Ahmed Alshaarawy is an excellent and compassionate clinician, a surgeon on the cutting edge of corneal transplant techniques, and a scientist with unique perspectives and boundless energy that will lead to exciting discoveries in our field. Whatever clinical and academic program he chooses will benefit immensely from his membership. Mark A. Terry, M.D., Director, Corneal Services, Devers Eye Institute, January 25, 2015.

Tripoli, March 2022

Libya's national corneal transplant programme

Visiting surgeon for the programme the Libyan Ministry of Health launched at Tripoli University Hospital: about 20 corneal transplants in one week, restarting the surgery there after a pause of nearly eight years.

The full story and sources

Do you wake up with foggy vision?

Corneal edema symptoms as you actually see them

Endothelial dystrophy (Fuchs / inner-cell loss) causes foggy vision that's worst in the morning and improves slightly through the day. Drag the divider to see what patients experience.

Normal vision

With corneal edema

Driving at night

Soft halos and glare around lights, especially in low-light conditions

Read this text clearly

A clear inner cornea keeps vision crisp

Read this text clearly

A clear inner cornea keeps vision crisp

Normal vision

With corneal edema

Reading

Foggy as if looking through a misted window, worst in the morning

Normal vision

With corneal edema

Eye chart

Uniformly blurred letters, improves slightly through the day but never sharpens

Book an inner cornea assessment

A cell count and a corneal thickness scan show the state of the inner layer, not this picture.

Doctor's case explanation

An endothelial transplant for a young girl

Dr. Ahmed Shaarawy explains why he chose DSAEK for a child despite lens and iris problems, and why a child's age does not allow delay, with her mother on the experience.

"At this young age the child has to see well before reaching the age of 8."

★★★★★

Evidence-based comparison

DMEK vs DSAEK: which is better for endothelial disease?

Both procedures treat endothelial disease (Fuchs dystrophy, bullous keratopathy), but outcomes diverge. Every clinical outcome figure below comes from a named peer-reviewed paper with its PMID. The layer-thickness row is the accepted anatomical description of the two techniques, and the cost row is this clinic’s own pricing.

Probability of a rejection episode at 1 and 2 years

Data: Anshu A, Price MO, Price FW Jr, Ophthalmology 2012;119(3):536-540 (PMID 22218143). Kaplan-Meier analysis of 141 DMEK eyes vs 598 DSEK eyes at one centre under an identical steroid regimen. These are the only two time points the paper publishes.

DMEKlower rejection riskDSAEKhigher rejection risk

Bottom line: in that comparison DMEK eyes carried roughly 15× lower risk of a rejection episode than DSEK eyes (95% CI 2.0-111; P=0.008), and roughly 20× lower than penetrating keratoplasty. Median follow-up was 13 months; the paper publishes no five-year figures.

Criterion	DMEK	DSAEK
Tissue transferred and its thickness The accepted anatomical description of what each technique transplants, not an outcome taken from the papers cited below	Descemet's membrane + endothelium, ≈ 10-15 μm	posterior stroma + Descemet's + endothelium, ≈ 100-150 μm
Mean corrected visual acuity across published series Deng 2018; follow-up 5.7-68 months for DMEK, 9 months for DSEK	20/21-20/31	20/34-20/66
Cumulative probability of a rejection episode at 2 years Anshu 2012; one centre, one steroid regimen. Penetrating keratoplasty was 18% in the same comparison	1%	12%
Primary graft failure Pooled means from the 2018 AAO assessment	1.7% (0-12.5%)	5% (0-29%)
Graft detachment requiring air injection (re-bubble) The most common DMEK complication; the Cochrane review also found dislocation more frequent with DMEK (RR 5.40)	28.8% (0.2-76%)	14% (0-82%)
Surgical difficulty This is why DMEK is concentrated in a few centres, Dr. Shaarawy was the first to perform it in Egypt	High, requires expertise	Moderate
Suitability for complex eyes DSAEK handles silicone oil or uneven cornea better	Limited	Excellent choice
Estimated cost in Cairo This clinic's own pricing, not a published figure. The difference is small; the decision is clinical first	from $3,000	from $3,500

Tissue transferred and its thickness

DMEK

Descemet's membrane + endothelium, ≈ 10-15 μm

DSAEK

posterior stroma + Descemet's + endothelium, ≈ 100-150 μm

The accepted anatomical description of what each technique transplants, not an outcome taken from the papers cited below

Mean corrected visual acuity across published series

DMEK

20/21-20/31

DSAEK

20/34-20/66

Deng 2018; follow-up 5.7-68 months for DMEK, 9 months for DSEK

Cumulative probability of a rejection episode at 2 years

DMEK

DSAEK

12%

Anshu 2012; one centre, one steroid regimen. Penetrating keratoplasty was 18% in the same comparison

Primary graft failure

DMEK

1.7% (0-12.5%)

DSAEK

5% (0-29%)

Pooled means from the 2018 AAO assessment

Graft detachment requiring air injection (re-bubble)

DMEK

28.8% (0.2-76%)

DSAEK

14% (0-82%)

The most common DMEK complication; the Cochrane review also found dislocation more frequent with DMEK (RR 5.40)

Surgical difficulty

DMEK

High, requires expertise

DSAEK

Moderate

This is why DMEK is concentrated in a few centres, Dr. Shaarawy was the first to perform it in Egypt

Suitability for complex eyes

DMEK

Limited

DSAEK

Excellent choice

DSAEK handles silicone oil or uneven cornea better

Estimated cost in Cairo

DMEK

from $3,000

DSAEK

from $3,500

This clinic's own pricing, not a published figure. The difference is small; the decision is clinical first

The clinical outcome rows above (visual acuity, immune rejection, primary graft failure, and detachment requiring re-bubbling) come from the published literature, not from this clinic's own record: Deng SX et al., Ophthalmology 2018;125(2):295-310 (PMID 28923499); Anshu A, Price MO, Price FW Jr, Ophthalmology 2012;119(3):536-540 (PMID 22218143); Stuart AJ et al., Cochrane Database Syst Rev 2018;6(6):CD012097 (PMID 29940078); Melles GRJ et al., Cornea 2006;25(8):987-990 (PMID 17102683). The time windows quoted are those studies' follow-up periods, not five years. Two rows are not from those papers: the layer-thickness figures are the accepted anatomical description of what each technique transplants, and 'Estimated cost in Cairo' is this clinic's own pricing, not a published figure.

Choose DMEK if…

Diagnosis: uncomplicated Fuchs dystrophy or endothelial failure
Priority: best achievable visual acuity and lowest rejection risk
Eye is free of silicone oil or complex intraocular lenses

Choose DSAEK if…

Complex eye (silicone oil, complex IOL, uneven cornea)
Prior failed DMEK
Patient cannot keep strict face-up positioning

Clinical note: the final DMEK vs DSAEK decision depends on topography, endothelial cell count, and corneal status, not on aggregate figures alone. Dr. Shaarawy recommends the right technique after examination.

Book an exam to confirm which technique fits

Procedures & pricing

Transparent USD pricing.

Final cost is set after clinical examination. Local-currency equivalents available on request. Insurance reports issued for international patients.

Procedure	Best for	From (USD)
DSAEK (standard)	Conventional DSAEK with a 100-150 micron stromal layer + endothelium.	$3,500 - $4,500
Ultra-thin DSAEK (UT-DSAEK)	Prepared to 50-100 microns. Closer visual outcome to DMEK.	$3,500 - $4,500
DSAEK + cataract surgery (triple)	Combined procedure for Fuchs patients with cataract.	$3,900 - $4,900

تجربة مريض حقيقية

Watch a real patient's experience with Dr. Ahmed Shaarawy

A real patient goes through the whole case, from diagnosis to restored vision after endothelial corneal transplantation.

Common questions

Frequently asked.

How is DSAEK different from DMEK?

DMEK transplants only the Descemet membrane and endothelium (~10-15 microns). DSAEK adds a thin layer of stroma (~50-150 microns). DMEK gives sharper vision and lower rejection but is more technically demanding and not feasible in some eyes. DSAEK is the right choice when DMEK isn't safe.

What's the recovery time for DSAEK?

Most patients see useful vision within 2-4 weeks; full visual stability takes 3-6 months. You'll need to keep your head face-up for the first 24 hours so the air bubble holds the graft.

What's the rejection risk?

Endothelial keratoplasty carries a significantly lower rejection risk than full-thickness penetrating keratoplasty, and DSAEK sits between DMEK and PKP on that scale (Anshu, Price & Price, Ophthalmology. 2012;119(3):536-540, PMID 22218143). Most rejection episodes respond to topical steroids if caught early, which is why the follow-up schedule matters. See the references below.

I had a glaucoma drainage tube. Can I have DSAEK?

Yes, DSAEK is often the right choice in eyes with glaucoma drainage devices. The thicker graft handles the modified anterior segment better than DMEK. We'll evaluate your specific case to confirm.

How long do I need to be in Cairo?

Plan for at least 7 days. Day 1: full pre-op evaluation. Day 2-3: surgery and immediate review. Days 4-7: short follow-ups. After that, follow-up can shift to your local ophthalmologist with our protocol.

Can I have DSAEK if I had LASIK or RK before?

Yes, and DSAEK is often the safer choice for these eyes. This is a co-authored research paper Dr. Ahmed Shaarawy contributed to, published as a poster at the AAO 2014 Annual Meeting (Terry MA, Straiko MD, Veldman PB, Alshaarawy AM [Dr. Ahmed Shaarawy], Mayko Z, Poster #30039964): endothelial keratoplasty is feasible and beneficial in eyes with prior LASIK or radial keratotomy. The thicker DSAEK graft handles the modified anterior segment more forgivingly than DMEK in many of these eyes. Clinical caveat: clearing the corneal edema may unmask topography changes from the prior refractive surgery, so plan for a glasses update around month 3.

Book your consultation

Pick a day and time. The first visit is an eye exam with Dr. Ahmed Shaarawy, who tells you which option suits your eyes.

Send your case for a DSAEK or DMEK recommendation.

We'll review your specular microscopy, OCT, and any prior surgical history and recommend whether DMEK, DSAEK, or another transplant approach is right for your eye, and the all-in cost.

Book a consultation Chat on WhatsApp

Medical references

Anshu A, Price MO, Price FW Jr. "Risk of corneal transplant rejection significantly reduced with Descemet's membrane endothelial keratoplasty." Ophthalmology. 2012;119(3):536-540. PMID: 22218143. rejection risk after DMEK significantly lower than after DSEK or penetrating keratoplasty.
Hos D, Tuac O, Schaub F, et al. "Incidence and Clinical Course of Immune Reactions after Descemet Membrane Endothelial Keratoplasty: Retrospective Analysis of 1000 Consecutive Eyes." Ophthalmology. 2017;124(4):512-518. PMID: 28094043. probability of an immune reaction 2.3% at four years.
Dr. Ahmed Shaarawy: 20+ years of corneal and refractive surgery, Devers Eye Institute fellowship (Portland, Oregon), two surgical techniques published in the AAO video series. The figures on this page come from the published literature, not from this clinic's own patients.

DSAEK in Cairo: the safer alternative when DMEK isn't possible.

International standard. Regional access.

Devers Eye Institute fellowship

When DMEK isn't safe, DSAEK is

Faster than full corneal transplant

Internationally sourced tissue

In Prof. Mark Terry's own words

Libya's national corneal transplant programme