DMEK, DSEK, and PKP — performed by fellowship-trained cornea specialist Dr. Bonnie Sklar. Modern corneal transplantation replaces only the diseased layer whenever possible, giving faster recovery, better vision, and lower rejection rates. Five Los Angeles-area locations.
Modern corneal transplantation has evolved dramatically — today, most procedures replace only the diseased layer, resulting in faster recovery, better vision, and lower rejection rates. Dr. Sklar will determine which approach is right for your diagnosis and anatomy.
DMEK
Descemet Membrane Endothelial Keratoplasty replaces only the innermost corneal layer — the layer most affected in Fuchs’ dystrophy. It offers the fastest visual recovery, lowest rejection risk, and best long-term outcomes of any corneal transplant technique.
DSEK
Descemet Stripping Endothelial Keratoplasty (DSEK/DSAEK) replaces inner corneal layers with a slightly thicker donor graft than DMEK. An excellent option for endothelial disease, with recovery faster than full-thickness PKP.
PKP
Penetrating Keratoplasty replaces the entire cornea and remains the procedure of choice when disease affects multiple layers — advanced keratoconus, corneal scarring from infection, or trauma.
Corneal transplant surgery becomes necessary when medical management, cross-linking, or other interventions can no longer restore adequate vision or comfort.
Gradual failure of corneal endothelial cells causing swelling and cloudy vision. DMEK is the preferred treatment and delivers excellent outcomes.
DMEK preferredWhen cross-linking and contact lenses can no longer correct vision, PKP or DMEK may be required for advanced or scarred keratoconus.
PKP or DMEKDense scarring from infection or injury that cannot be corrected with glasses or contact lenses may require transplantation.
Usually PKPPainful corneal blistering caused by endothelial failure — often following prior intraocular surgery. DMEK or DSEK are typically most appropriate.
DMEK or DSEKSevere infections that leave permanent corneal opacity may require transplantation to restore functional vision.
Usually PKPCorneal grafts can fail months or years after surgery. Re-grafting is often possible and may use a different technique than the original.
Depends on caseFrom your first imaging appointment through visual rehabilitation, here is how corneal transplant surgery unfolds at Berg-Feinfield.
Corneal tomography, pachymetry, endothelial cell count, and anterior segment imaging. Dr. Sklar uses this data to determine which procedure is best and what outcomes to realistically expect.
Donor tissue is obtained through an accredited eye bank and carefully screened for quality. DMEK tissue requires specialized preparation, and surgery is coordinated in alignment with tissue availability.
Performed on an outpatient basis under local anesthesia with sedation. DMEK and DSEK take approximately 1–2 hours. You will need someone to drive you home.
You will be seen the following day and frequently in the weeks and months after surgery. DMEK requires face-down positioning for 24 hours. Long-term steroid drops prevent rejection.
Vision improves gradually as the graft heals. DMEK patients often see meaningful improvement within weeks; PKP patients typically stabilize over 12–18 months.
Rejection warning: sudden vision loss, redness, light sensitivity, or pain — contact us immediately at 866-2-SEE FAR. Do not wait for a scheduled appointment. Rejection is treatable when caught early.
Before recommending any transplant procedure, Dr. Sklar performs comprehensive corneal tomography, topography, and pachymetry — creating a detailed 3D map of your cornea that determines which procedure will produce the best outcome for your specific anatomy. The right technique depends entirely on your diagnosis, corneal thickness, and which layers are affected.
Schedule Your Evaluation
The right procedure depends entirely on your diagnosis, corneal anatomy, and disease severity. Dr. Sklar will evaluate your specific case and recommend the approach most likely to deliver the best outcome.
| DMEK | DSEK / DSAEK | PKP | |
|---|---|---|---|
| Tissue Replaced | Descemet’s membrane + endothelium | Endothelium + thin posterior stroma | Full-thickness cornea |
| Incision Size | Smallest | Small, typically larger than DMEK | Full circular incision |
| Visual Recovery | Typically fastest | Typically moderate | Typically slowest |
| Rejection Risk | Lowest | Low to moderate | Higher |
| Sutures Required | Usually no graft sutures | Usually no graft sutures; wound sutures may be used | Yes |
| Primary Indication | Fuchs’ dystrophy, endothelial dysfunction/failure, bullous keratopathy | Endothelial disease, complex endothelial cases | Corneal scarring, advanced keratoconus, full-thickness disease |
Corneal transplant surgery — particularly DMEK — is among the most technically demanding procedures in ophthalmology. The surgeon's training, case volume, and experience with each technique directly affect outcomes.
Fellowship in Cornea, External Disease & Refractive Surgery at Duke University Eye Center — one of the nation's foremost training programs.
Ophthalmology residency at Wills Eye Hospital in Philadelphia — consistently ranked among the top programs in the world. MD from the Icahn School of Medicine at Mount Sinai.
Surgical training across DMEK, DSEK, PKP, and the full range of anterior segment corneal procedures — not all corneal surgeons perform every technique.
Golden Apple Award for teaching at Duke Eye Center, peer-reviewed publications, national conference presenter, and humanitarian surgical missions in Honduras, Sierra Leone, Kenya, and Mongolia.
“Modern corneal transplantation has transformed outcomes for patients with Fuchs’ dystrophy and endothelial disease. DMEK gives patients a realistic expectation of excellent vision with a fraction of the recovery burden of older techniques.”
Berg-Feinfield serves patients across the Los Angeles metropolitan area from five locations — in the San Fernando Valley, the Westside, the San Gabriel Valley, and the Santa Clarita Valley.
San Fernando Valley
2625 W. Alameda Ave.
Suite 208
Burbank, CA 91505
(818) 845-3557
Mid-San Fernando Valley
13320 Riverside Drive
Suite 114
Sherman Oaks, CA 91423
(818) 501-3937
Westside Los Angeles
462 N. Linden Drive
Suite 441
Beverly Hills, CA 90212
(866) 273-3327
San Gabriel Valley
638 W. Duarte Road
Suite 10
Arcadia, CA 91007
(626) 795-9793
Santa Clarita Valley
27335 Tourney Road
Suite 210
Valencia, CA 91355
(866) 273-3327
Whether you've been recently diagnosed with Fuchs’ dystrophy, referred for a keratoconus transplant evaluation, or are seeking a second opinion — Dr. Sklar and the Berg-Feinfield cornea team are ready to see you.
