Descemet Stripping Automated Endothelial Keratoplasty in Pediatric Age Group: A Decade of Our Experience

Abstract

This study was to report the outcomes of Descemet stripping automated endothelial keratoplasty (DSAEK) in managing corneal endothelial disorders in children less than 14 years of age.Methods: Medical records of 180 DSAEK performed, between 2008 and 2020, on 167 eyes of 111 children who had a visually significant endothelial dysfunction were retrospectively reviewed for the primary etiology of corneal decompensation, time of the onset and duration of cloudiness, preoperative visual acuity, the technique of endothelial keratoplasty, surgical modifications, and reintervention.Results: Median age at surgical intervention was 7.9 years (interquartile range, 5.2-11.2 years). At a median postinterventional follow-up of 2.5 years (interquartile range, 0.9-3.4 years), 86.2% (144 of 167 eyes, 95% confidence interval 79.9%-90.1%) maintained a clear graft. Median best-corrected visual acuity (logarithm of the minimum angle of resolution) improved from 1.45 6 0.70 preoperatively to 0.90 6 0.06 at the last follow-up visit (P , 0.0001). The cumulative overall long-term graft survival was 92.7%, 86.5%, and 77.7% at 1, 3, and 7 years, respectively. Cox proportional hazards regression analysis showed that the indication for DSAEK (P = 0.007; hazards ratio: 2.17 6 0.62), age at surgery (P = 0.02; hazards ratio: 0.87 6 0.05), and any subsequent intervention after DSAEK (P = 0.003; hazards ratio: 0.11 6 0.08) were significant risk factors for DSAEK failure. The endothelial cell loss was 40.1% at 6 months, 45.4% at 1 year, 55.2% at 5 years, and 61.9% at 7 years.Conclusions: DSAEK is a safe and effective surgical strategy in managing endothelial disorders among the pediatric age group.

Outcomes of Corneal Transplant in Childhood Glaucoma

“…Although PK has been the technique most widely used to treat corneal endothelial failure in pediatric transplantations, 49 recently other techniques such as anterior or posterior lamellar keratoplasties have been used with success 30–37 . In the Corneal Preservation Time Study, 50 eyes that had undergone surgery for glaucoma had a lower 3-year graft success rate after DSAEK (80.1% vs 94.1% for eyes without glaucoma surgery) 50 .…”

“…Although PK has been the technique most widely used to treat corneal endothelial failure in pediatric transplantations, 49 recently other techniques such as anterior or posterior lamellar keratoplasties have been used with success. [30][31][32][33][34][35][36][37] In the Corneal Preservation Time Study, 50 eyes that had undergone surgery for glaucoma had a lower 3year graft success rate after DSAEK (80.1% vs 94.1% for eyes without glaucoma surgery). 50 However, the subgroups with glaucoma surgery alone, those with prior surgery and medication, and those with medication alone were too small to conduct further analyses on different factors that could influence subsequent graft success.…”

“…Until recent years, the most widely used technique to treat corneal endothelial failure in pediatric patients was penetrating keratoplasty (PK) (Kim and colleagues, 2018). Recently, however, other posterior lamellar techniques such as Descemet stripping automated endothelial keratoplasty (DSAEK) or Descemet membrane endothelial keratoplasty (DMEK) have been used with success in pediatric patients 30–37 . Various studies have analyzed the results of corneal transplantation in pediatric patients, but have not dealt specifically with its results in pediatric glaucoma patients 38–41 .…”

“…Recently, however, other posterior lamellar techniques such as Descemet stripping automated endothelial keratoplasty (DSAEK) or Descemet membrane endothelial keratoplasty (DMEK) have been used with success in pediatric patients. [30][31][32][33][34][35][36][37] Various studies have analyzed the results of corneal transplantation in pediatric patients, but have not dealt specifically with its results in pediatric glaucoma patients. [38][39][40][41] Therefore, the aim of the present study is to evaluate the results of corneal transplantation in patients diagnosed with childhood glaucoma.…”

Pediatric corneal transplantation: techniques, challenges, and outcomes

“… 88 , 89 Ramappa et al reported 10-year outcomes of DSAEK in 180 pediatric eyes and found improved and safe outcomes with this technique. 90 …”