DSO (Descemet Stripping Only) – also called DWEK – is a transplant-free operation for Fuchs endothelial dystrophy. The surgeon strips away a small central disc of the diseased inner lining of your own cornea (the Descemet membrane and its endothelial cells) and removes nothing else. Your healthy peripheral endothelial cells then proliferate and migrate inwards to recoat the bare zone, so the cornea clears using your own tissue – with no donor graft, no rejection risk and no lifelong steroid drops.
What DSO does for Fuchs dystrophy
In Fuchs endothelial dystrophy the pump cells on the back of the cornea (the endothelium) gradually fail, so fluid builds up and the cornea swells – causing morning blur, glare and loss of contrast. Traditionally the fix is to replace that layer with thin donor tissue (a DMEK or DSAEK transplant). DSO takes a different route: in eyes where the periphery of the endothelium is still healthy, removing just the diseased central disc lets the surrounding good cells spread across and restore a clear cornea.
In well-selected eyes the final vision is comparable to a DMEK transplant, but without donor tissue, with a much lower long-term steroid burden, zero graft-rejection risk, and full preservation of the option to have DMEK later if the cornea does not clear. The trade-off is a slower, less certain recovery, which is why careful case selection matters.
The Fuchs endothelial treatment pathway
Treatment is matched to how advanced your Fuchs dystrophy is and how healthy your peripheral endothelium remains. DSO is the most conservative surgical option; DMEK and ultra-thin DSAEK are donor-tissue transplants for more advanced disease or when the periphery is too depleted for DSO to work.
If you also have a cataract, DSO is frequently combined with cataract surgery in a single operation. Your consultant will recommend the right step after specular microscopy and corneal mapping.
Wondering whether your cornea suits transplant-free DSO or needs a DMEK graft? One consultation with specular microscopy gives a clear answer.
Book your assessmentHow DSO surgery is done
DSO is a short day-case procedure under topical anaesthetic drops – no general anaesthetic and no overnight stay. Through a tiny 2.2–2.4mm clear-corneal incision, the surgeon uses a fine hook to fashion a central 3.5–4.5mm descemetorhexis and peels away the diseased disc of Descemet membrane and endothelium in one piece, leaving the stroma and the healthy peripheral endothelium untouched.
No donor tissue is implanted and stitches are rarely needed. If a cataract is present, phacoemulsification with a lens implant is performed in the same session. Standalone DSO usually takes around 15–25 minutes; combined DSO and cataract surgery around 25–40 minutes. A clear protective shield is applied and you go home the same day.
Recovery and aftercare
First 1–2 days
A gritty, watery sensation is common and settles with lubricants. Wear the night shield, avoid eye rubbing, and start your antibiotic and steroid drops as prescribed.
First weeks
Vision is often hazy at first while the central cornea is still clearing. ROCK inhibitor drops (such as netarsudil) can encourage endothelial cells to migrate and shorten the time to clearance, but they are not currently licensed in the UK and, where used, are obtained by your surgeon on a named-patient (unlicensed import) basis.
4–12 weeks
Most patients notice gradual improvement as the cornea clears; a few clear within days. Reviews at 1, 3 and 6 months repeat specular microscopy and pachymetry to track progress.
If it does not clear
In about 15–25% of eyes the cornea fails to clear. The straightforward backup is a DMEK transplant, performed without compromise to the eye or the final visual result.
DSO cost in the UK (2026)
Private self-pay DSO in the UK in 2026 is typically £4,500–7,500 per eye, or £6,500–9,500 per eye when combined with phacoemulsification cataract surgery and a monofocal lens implant. That is broadly in line with, or slightly below, private DMEK pricing and represents good value for the right patient.
Most major UK insurers (Bupa, AXA, Aviva, Vitality, WPA) fund DSO when it is clinically indicated for Fuchs dystrophy, billed against the appropriate CCSD code with pre-authorisation; any premium lens upgrade in a combined cataract and DSO procedure is normally self-pay. See our corneal transplant cost guide or the full price list.
DSO for Fuchs dystrophy FAQs
DSO (Descemet Stripping Only) removes only the diseased central layer of your own cornea (Descemet membrane and endothelium) and lets your healthy peripheral endothelial cells migrate inwards to recoat the area. No donor tissue is used. DMEK and DSAEK transplants instead replace the diseased layer with thin donor tissue from a corneal donor and carry a small lifelong rejection risk.
In selected mild-to-moderate Fuchs endothelial dystrophy with a healthy peripheral endothelium, DSO offers comparable final visual outcomes to DMEK without using donor tissue, with a lower long-term steroid burden, zero graft-rejection risk, and full preservation of the option to have DMEK later if needed.
Most patients notice gradual improvement in vision over 4 to 12 weeks as the central cornea clears and endothelial cells migrate centrally. A small number clear within days, while others take longer; adjunctive ROCK inhibitor drops can shorten the time to clearance, though these are not licensed in the UK and are only available on a named-patient basis.
In approximately 15 to 25 percent of well-selected eyes the cornea fails to clear after DSO. The straightforward backup is a DMEK transplant, which can be performed without compromise to the eye or the final visual result.
Yes, frequently. Combined DSO and phacoemulsification cataract surgery with an intraocular lens implant is well established and means a single operation, one recovery and a single set of post-operative visits, with the option of standard or premium IOLs.
No. Because no donor tissue is implanted, there is no graft to reject, and topical steroid drops can usually be tapered off after a few months. This is one of the key advantages of DSO over DMEK and DSAEK transplants.