10‐year experience with lamellar keratoplasty for the surgical Management of Paediatric Corneal Diseases

Abstract

Purpose To evaluate the outcomes of various lamellar keratoplasty techniques performed at our Institution in children aged 14 years or younger over the last decade. Methods This single‐centre study reviewed 72 eyes that underwent lamellar keratoplasty for various indications. Deep anterior lamellar keratoplasty (DALK) was performed in 19 eyes, mushroom penetrating keratoplasty (PK) in 27 eyes and Descemet stripping automated endothelial keratoplasty (DSAEK) in 25 eyes. The main outcome measures included best spectacle‐corrected visual acuity (BSCVA), complications and rate of graft failure which was defined as any graft requiring repeat transplantation. Results Best spectacle‐corrected visual acuity (BSCVA) significantly improved after DALK, mushroom PK and DSAEK (all p < 0.05), with 50%, 60% and 56% of eyes reaching ≥20/40, respectively. Stromal rejection was observed in 1 eye (5.3%) after DALK, whilst endothelial rejection occurred in 1 eye after mushroom PK (3.7%) and 1 eye after DSAEK (4.0%). Overall survival was 100% after DALK (mean follow‐up: 23.0 months), 92.8% after mushroom PK (mean follow‐up: 42.3 months) and 96.0% after DSAEK (mean follow‐up: 33.6 months). Conclusion Deep anterior lamellar keratoplasty (DALK), mushroom PK and DSAEK offer good visual outcomes for children with corneal pathology, with low rates of immunological rejection and graft failure.

Outcomes of Corneal Transplant in Childhood Glaucoma

“…Corneal edema usually occurs in advanced and/or uncontrolled disease and is usually due to corneal endothelial cell loss secondary to uncontrolled IOP and/or repeat anterior segment surgeries 28 . When corneal edema persists even when the IOP has been lowered, corneal transplantation should be attempted to return vision and prevent amblyopia in pediatric patients 29 …”

“…28 When corneal edema persists even when the IOP has been lowered, corneal transplantation should be attempted to return vision and prevent amblyopia in pediatric patients. 29 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.…”