Pediatric Descemet Membrane Endothelial Keratoplasty

Srinivasan, Bhaskar; Agarwal, Manokamna; Iyer, Geetha; Agarwal, Shweta; Padmanabhan, Prema

doi:10.1016/j.ajo.2021.02.011

Cited by 9 publications

(11 citation statements)

References 27 publications

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“…[ 40 41 ] To date, only four studies have evaluated the anatomical and functional outcomes of DMEK and n-DMEK in CHED eyes. [ 11 12 13 14 ]…”

Section: Resultsmentioning

confidence: 99%

“… Surgical Technique Donor tissue preparation: In all the studies, donor DM stripping was performed intraoperatively before DMEK surgery by using a standard approach. [ 11 12 13 14 ] After scoring of the peripheral endothelium–Descemet membrane (EDM), it is carefully separated from the underlying stroma by using a pair of McPherson forceps under 1–2 drops of the storage medium (submerged cornea under backgrounds away technique) till 1–2 mm short of completion such that a peripheral hinge of stromal–EDM adhesion is left. The stripped EDM is floated back using the storage medium, leaving one-half of the corneal stroma exposed for the creation of a stromal window.…”

Section: Resultsmentioning

confidence: 99%

“…The effectiveness of DMEK in the management of CHED has been very recently documented in the literature with favorable visual outcomes. [ 11 12 13 14 ]…”

mentioning

confidence: 99%

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A review of techniques and outcomes of endothelial keratoplasty in congenital hereditary endothelial dystrophy

Mandal

Asif

Maharana

et al. 2022

Indian Journal of Ophthalmology

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Congenital hereditary endothelial dystrophy affects the Descemet membrane and endothelium, resulting in corneal decompensation. Penetrating keratoplasty (PKP) has been the gold-standard surgical management until recently; however, at present, endothelial keratoplasty (DSEK/DSAEK/n-DSEK: Descemet-stripping or non-Descemet stripping endothelial keratoplasty and DMEK/n-DMEK: Descemet membrane endothelial keratoplasty) is being preferred due to lesser intraoperative and postoperative complications, early visual recovery, and comparable visual outcomes. Endothelial keratoplasty (EK) can be challenging, especially in pediatric eyes with CHED due to smaller eyeballs, shallow anterior chambers, phakic status, and poor intraoperative visibility due to thick and hazy corneas. A total of 198 articles matched our search strategy. After screening for duplication and going through the titles and abstracts, 12 relevant original articles, one case series, and six case reports were included in this review. Various surgical modifications have to be adopted in comparison to adult eyes to overcome the aforementioned difficulties. Regardless, studies have shown favorable visual outcomes with better graft survival and fewer complications in eyes that underwent EK compared to PKP. Hence, timely surgical intervention and strict amblyopia management can result in better final visual outcomes. The purpose of this review is to summarize various intraoperative difficulties and the surgical modifications required, different surgical techniques, visual and graft-related outcomes, and various complications of EK in CHED eyes.

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“…[ 40 41 ] To date, only four studies have evaluated the anatomical and functional outcomes of DMEK and n-DMEK in CHED eyes. [ 11 12 13 14 ]…”

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

A review of techniques and outcomes of endothelial keratoplasty in congenital hereditary endothelial dystrophy

Mandal

Asif

Maharana

et al. 2022

Indian Journal of Ophthalmology

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“… 18 DMEK could be challenging especially in pediatric eyes, however, results are encouraging with favourable outcomes. 19 Saad et al 20 performed DMEK in 14 eyes of 8 CHED patients and reported good visual outcomes.…”

Section: Discussionmentioning

confidence: 99%

Microscope Integrated Optical Coherence Tomography Guided Descemet Stripping Automated Endothelial Keratoplasty in Congenital Hereditary Endothelial Dystrophy

Asif

Bafna

Sharma

et al. 2021

OPTH

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Purpose: To describe the outcomes of descemet stripping automated endothelial keratoplasty (DSAEK) in congenital hereditary endothelial dystrophy (CHED) and to evaluate the role of microscope integrated optical coherence tomography (Mi-OCT) during the surgery. Design: Retrospective data analysis. Methods: A retrospective study from the medical records of all those patients who were diagnosed with CHED and underwent DSAEK at our centre from 2015 were evaluated. All patients underwent Mi-OCT-guided standard DSAEK procedure. Intra-operative difficulties, visual outcomes and graft survival were recorded. Results: A total of 48 eyes of 29 patients with a mean age of 9.87 ± 8.2 years and mean follow-up of 17.3 months were evaluated. Thirty-nine eyes underwent primary DSAEK and 9 eyes underwent PKP. Three eyes who underwent PKP had failed graft for which they underwent DSAEK. The mean preoperative Snellen's visual acuity was 1.71 ± 0.66 and the mean preoperative central corneal thickness was 1.10 ± 0.174 mm. Intraoperatively, all the grafts were attached which was confirmed using Mi-OCT. Graft detachment was seen in the immediate postoperative period in 10.4% (4 eyes) of primary DSAEK, out of which DM scoring was not performed in 2 eyes. Following DSAEK, cornea cleared at four-week follow-up in 89.7% eyes and in all the eyes the cornea cleared at six-week follow-up. Conclusion: Primary DSAEK could be a preferred option over PKP for CHED with early presentation and in those eyes with failed primary PKP. Mi-OCT is a very useful tool in these eyes for various intraoperative procedures, thereby improving the outcomes of the procedure.

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“…In one series of five eyes (age 6–15 years), two eyes where Descemet was not peeled required re-bubbling, four eyes had anatomical success with corneal clearing and one eye had a primary graft failure [43]. In another series of 12 eyes from eight patients (age 3–8 years) 6/12 omitted Descemet stripping; and one of these required postoperative successful rebubbling and 0/12 had intraoperative complications using intraoperative OCT [46].…”

Section: Pediatric Populationmentioning

confidence: 99%

Descemet membrane endothelial keratoplasty in complex eyes

Siddiqui

Chamberlain

2022

Current Opinion in Ophthalmology

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Purpose of reviewTo review the current literature on Descemet membrane endothelial keratoplasty (DMEK) in complex eyes.Recent findingsDMEK surgery has become a standardized procedure in Fuchs endothelial dystrophy and simple bullous keratopathy. But eyes with more complex disease present unique intraoperative and postoperative challenges to the DMEK surgeon. Poor visualization during surgery, complex anterior segment anatomy, altered anterior chamber dynamics, glaucoma shunts, and congenital or iatrogenic missing or altered iris and lens make DMEK surgery extremely difficult to accomplish.SummaryDMEK is feasible in complex eyes, including advanced bullous keratopathy, eyes with history of glaucoma or vitreoretinal surgery, previous penetrating keratoplasty, uveitis, pediatric, and congenital anterior segment disorders. The tools and methods reported in the literature to accomplish DMEK in complex eyes vary widely with no particular consensus or standardization of techniques. The outcomes noted for some of these conditions demonstrate the difficulty of the surgery and the uncertainty of long-term graft survival in complex eyes. Both surgical standardization and randomized prospective data will better help elucidate DMEK's role in the corneal rehabilitation of complex eyes.

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Pediatric Descemet Membrane Endothelial Keratoplasty

Cited by 9 publications

References 27 publications

A review of techniques and outcomes of endothelial keratoplasty in congenital hereditary endothelial dystrophy

A review of techniques and outcomes of endothelial keratoplasty in congenital hereditary endothelial dystrophy

Microscope Integrated Optical Coherence Tomography Guided Descemet Stripping Automated Endothelial Keratoplasty in Congenital Hereditary Endothelial Dystrophy

Descemet membrane endothelial keratoplasty in complex eyes

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