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Updated: Mar 23, 2026
Corneal Donor Tissue Preparation for Endothelial Keratoplasty
Published on: June 12, 2012
Long-Term Corneal Endothelial Cell Counts After Penetrating Keratoplasty in Infants
Uri Elbaz1, Asim Ali, Kamiar Mireskandari
1Department of Ophthalmology and Vision Sciences, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.
Insights
Pediatric penetrating keratoplasty (PKP) in infants shows significant long-term endothelial cell loss, but less than in adults. Iris adhesions are linked to lower cell counts post-surgery.
Area of Science:
- Ophthalmology
- Transplantation Surgery
- Pediatric Eye Care
Background:
- Infantile corneal disease often necessitates penetrating keratoplasty (PKP).
- Long-term outcomes of PKP in infants are not well-established.
- Endothelial cell density (ECD) is a critical indicator of graft survival.
Purpose of the Study:
- To evaluate long-term endothelial cell counts following PKP in infants.
- To assess endothelial cell loss over time in pediatric corneal transplants.
- To identify factors associated with endothelial cell survival post-PKP in children.
Main Methods:
- Retrospective chart review of children under one year old undergoing PKP.
- Inclusion criteria: single successful transplant with post-operative ECD analysis.
- Specular microscopy used to calculate endothelial cell loss; general anesthesia for imaging in young children.
Main Results:
- Study included 21 eyes from 16 infants with a median follow-up of 49 months.
- Median endothelial cell loss was 59.2% from pre-keratoplasty levels.
- Iris adhesions to the graft-host junction were significantly associated with lower final ECD (P=0.01).
Conclusions:
- Pediatric PKP demonstrates substantial long-term endothelial cell loss.
- Despite challenges, pediatric PKP shows lower endothelial cell loss compared to adult PKP.
- Close monitoring for complications like iris adhesions is crucial for graft longevity.
Purpose:
To report long-term endothelial cell counts after penetrating keratoplasty (PKP) in infants.
Methods:
The charts of all children who have undergone PKP in their first year of life between 1998 and 2013 at the Hospital for Sick Children, Toronto, Canada, were reviewed retrospectively. Patients who had a single successful transplant with a valid endothelial cell density (ECD) analysis postsurgery were included in the study. Donor ECDs were provided by a local eye bank. Specular microscopy images were taken at a variable interval after surgery using a noncontact specular microscope (ROBO, Konan; Konan Medical) and endothelial cell loss was calculated. In young children images were taken in the lateral decubitus position under general anesthesia.
Results:
Twenty-one eyes of 16 patients were included in the study. Median patient age at the time of surgery was 2.0 months [mode, 2.0; interquartile range (IQR), 1.6-2.6 months] and median follow-up time was 49.0 months (IQR, 33.0-99.5 months). The most common indication for surgery was Peters anomaly, in 16 eyes (76.2%). Ten eyes had additional intraocular surgeries posttransplant. The median ECDs prekeratoplasty and at last follow-up were 2958 cells per square millimeter (IQR, 2807-3205 cells/mm) and 1307 cells per square millimeter (IQR, 946-1613 cells/mm) respectively, reflecting a median endothelial cell loss of 59.2% (IQR, 44.3%-68.8%). Iris adhesions to the graft-host junction were strongly associated with low final ECD (P = 0.01).
Conclusions:
Despite technical challenges and difficult postoperative care, pediatric keratoplasty is associated with a lower endothelial cell loss over time compared with that reported in adults after PKP.
