PDEK (pre-Descemet's endothelial keratoplasty) is a partial-thickness corneal transplant that replaces only the diseased endothelial cell layer of the cornea, together with the thin pre-Descemet (Dua's) layer. It is used to treat Fuchs endothelial dystrophy and other causes of corneal endothelial failure, restoring a clear cornea while preserving the rest of your healthy tissue. At our partner clinics, private PDEK starts from £5,500 per eye, all-inclusive of the consultant corneal surgeon, donor tissue, theatre and aftercare.
What is PDEK and why is it needed?
The innermost layer of the cornea — the endothelium — is a single sheet of pump cells that keep the cornea clear by removing excess fluid. In Fuchs endothelial dystrophy, these cells gradually fail, so the cornea swells and clouds, causing misty vision (often worst on waking), glare and halos. Endothelial cells do not regenerate, so once vision is significantly affected, the only definitive treatment is to replace the failed layer.
PDEK does exactly this. Rather than transplanting the whole cornea, the surgeon replaces only the thin endothelial layer with healthy donor tissue. Because the graft is so thin and the rest of your cornea is preserved, vision recovers faster, the eye is structurally stronger, and the risk of graft rejection is lower than with a traditional full-thickness transplant.
Conditions PDEK can treat
- Fuchs endothelial dystrophy — the most common indication
- Bullous keratopathy — corneal swelling after previous eye surgery
- Endothelial failure after cataract or other intraocular surgery
- Failed previous endothelial grafts needing a repeat procedure
Misty morning vision or glare from Fuchs? A corneal assessment with scans confirms whether an endothelial transplant will help.
Book a corneal assessmentPDEK and related endothelial grafts
Several endothelial keratoplasty techniques exist. Your consultant recommends the most suitable one for your cornea, donor tissue availability and the stage of your disease.
For early Fuchs, your surgeon may also discuss Descemet stripping only (DSO), which removes the central diseased cells without a donor graft, or the donor-free EndoArt artificial endothelial graft. Patients with deeper corneal scarring may instead need a DALK or full-thickness transplant.
What happens during PDEK surgery
PDEK is a day-case procedure performed under local or general anaesthetic, taking around 30–45 minutes.
- The donor endothelial tissue, including the pre-Descemet layer, is prepared into a thin graft (a small air bubble technique helps separate the layer cleanly).
- The surgeon makes a tiny incision and removes your diseased endothelium (descemetorhexis).
- The rolled donor graft is inserted, unfolded and positioned against the back of your cornea.
- An air or gas bubble is placed in the eye to press the graft into position while it adheres.
- You rest, then go home the same day with instructions to lie face-up to keep the bubble supporting the graft.
Recovery week-by-week
Vision clears more gradually than with cataract surgery, as the new endothelial cells start pumping fluid out of the cornea. Positioning in the first days is important.
Days 1–3
Lie face-up as advised so the bubble supports the graft. Vision is blurry while the cornea is still swollen. Drops begin.
Weeks 1–2
The bubble absorbs and the cornea starts to clear. First reviews confirm the graft is attached and the eye pressure is settled.
Weeks 3–8
Vision improves steadily as the cornea deturgesces. Anti-rejection steroid drops continue at a reducing dose.
3–6 months
Vision reaches its final, clear level. Long-term low-dose steroid drops help protect against rejection.
Cost & insurance
Our PDEK prices are all-inclusive: consultation and corneal scans, the surgery, theatre and hospital fees, donor tissue and eye-bank charges, post-op drops and your follow-up reviews.
- Self-pay: from £5,500 per eye for PDEK. Related endothelial grafts (DMEK, DSAEK) are individually quoted at consultation.
- Insurance: corneal transplantation for Fuchs is usually covered — recognised by Bupa, AXA, Aviva, Vitality, Cigna, WPA and others. We handle authorisation.
- Finance: 0% options available to spread the cost.