Descemet stripping automated endothelial keratoplasty in pediatric age group

Abstract

PurposeTo report the outcomes of DSAEK surgery performed in pediatric patients. DesignNoncomparative interventional case series. Subjects and methodsAll pediatric patients (age up to 16years) undergoing Descemet automated stripping endothelial keratoplasty (DSAEK) at our Institution since January 2008 have been enrolled in a prospective study. A standard DSAEK, involving delivery of an 8.5–9.5mm graft by Busin glide, was performed under general anesthesia in 19 eyes of 11 pediatric patients (congenital hereditary endothelial dystrophy n=13; congenital glaucoma n=2; posterior polymorphous dystrophy n=2, and failed penetrating keratoplasty n=2). Slit-lamp examination, refraction and visual acuity as well as endothelial cell density were evaluated preoperatively as well as 1, 3, 6, 12, and 18months postoperatively. ResultsAll surgical procedures were uneventful. Graft detachment occurred in 4 cases and was managed successfully with repeat air injection. All corneas cleared within a week from surgery. Follow-up was 3–18months. At last follow-up examination, best-corrected visual acuity (BCVA) was better than 20/40 in 8 of the 13 cases of patients old enough to assess vision. A graft rejection episode was seen in 1 case within 3months from surgery but was reverted with steroidal treatment. No graft failures were observed. ConclusionsDSAEK is an appropriate surgical intervention for children with corneal endothelial failure. In contrast to penetrating keratoplasty (PK), DSAEK is performed under “closed system” conditions, thus minimizing intraoperative risks. Finally, healing is much faster than with PK and all sutures can be removed within 2–4weeks from surgery, thus allowing fast visual recovery and prompt starting of amblyopia treatment.