Descemet stripping automated endothelial keratoplasty in pediatric age group

Abstract

DSAEK 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 2-4 weeks from surgery, thus allowing fast visual recovery and prompt starting of amblyopia treatment.

Endothelial dysfunction in a child with Pearson marrow-pancreas syndrome managed with Descemet stripping automated endothelial keratoplasty using a suture pull-through technique

“…8 Furthermore, risk of lenticular trauma remains a critical concern since most pediatric patients are phakic. [9][10][11][12] Modified techniques for DSAEK insertion, for example, using a sheets glide to protect the lens, have been proposed to minimize lenticular trauma. 12 However, techniques for pediatric DSAEK continue to evolve.…”

Endothelial keratoplasty for posterior polymorphous corneal dystrophy in a 4-month-old infant

“…The use of ultrathin DSAEK could be potentially better and should be considered. There are only five reports 4 , 5 , 6 , 7 including one series 8 published in the literature of DSAEK in infants for CHED and PPCD with a follow-up from 3 to 24 months showing good graft survival without cataract formation. Lenhart et al.…”

“…DSAEK involves transplanting a thin layer of stroma, Descemet's membrane and endothelium and has been successfully performed in children. 4 , 5 , 6 , 7 , 8 In recent years, the technique of Descemet membrane endothelial keratoplasty (DMEK) has been developed, which involves transplanting only Descemet's membrane and endothelium. This technique has shown potential for faster and improved visual outcomes compared with DSAEK.…”

Visual outcome after Descemet's stripping automated endothelial keratoplasty in an 8-month-old with congenital hereditary endothelial dystrophy

“…It has been performed in children 1-5 but infrequently during infancy 6-10 (Table 1). We report successful DSAEK in a 8-month-old child with CHED with uncorrected visual acuity of 20/40 in the left eye at 24 months' follow-up.…”

“…There are also risks associated with DSAEK that may disproportionately affect younger children, who are generally phakic, with smaller anterior chambers and softer sclera. Technical challenges previously cited have included difficulties with Descemet's stripping 2 or inability to identify Descemet's membrane in infants < 12 months of age, 10 inadequate visualization due to corneal opacity, 2 lenticular touch, 8 graft dislocation, 4 and the requirement for prolonged general anesthesia due to the difficulty of maintaining an air bubble tamponade. 9 While early surgical intervention is advocated in children to avoid amblyopia, the optimal age for endothelial keratoplasty remains controversial.…”