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Updated: Feb 16, 2026
Corneal Donor Tissue Preparation for Endothelial Keratoplasty
Published on: June 12, 2012
Endothelial keratoplasty for posterior polymorphous corneal dystrophy in a 4-month-old infant
M Hermina Strungaru1,2, Asim Ali1, David Rootman1
1Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Canada.
Insights
This study presents the youngest case of endothelial keratoplasty (EKs) in a 4-month-old infant with posterior polymorphous corneal dystrophy. Descemet stripping automated endothelial keratoplasty (DSAEK) proved successful after a failed Descemet membrane endothelial keratoplasty (DMEK) attempt.
Area of Science:
- Ophthalmology
- Corneal Surgery
- Pediatric Ophthalmology
Background:
- Posterior polymorphous corneal dystrophy (PPCD) is a rare genetic disorder affecting corneal endothelium.
- Endothelial keratoplasty (EK) is a surgical option for corneal endothelial dysfunction.
- Infantile EK presents unique surgical challenges due to anatomical and physiological differences.
Observation:
- A 4-month-old infant with PPCD underwent Descemet membrane endothelial keratoplasty (DMEK).
- Postoperative graft dislocation occurred on day 5, with unsuccessful attempts to re-position the DMEK graft.
- The infant was subsequently treated with bilateral Descemet stripping automated endothelial keratoplasty (DSAEK).
Findings:
- This case represents the youngest patient to undergo EKs at 4 months of age.
- The initial DMEK procedure highlighted potential challenges in infant corneal transplantation.
- Successful visual outcomes (20/70 and 20/60) were achieved with DSAEK at 3-year follow-up.
Implications:
- DSAEK is a viable and effective treatment for infantile endothelial dysfunction secondary to PPCD, even after DMEK failure.
- This case underscores the importance of considering alternative EK techniques in pediatric patients.
- Further research into optimizing DMEK techniques for infants may be warranted.
Purpose:
To report a case of endothelial keratoplasties (EKs) performed in a 4 month old with a posterior polymorphous corneal dystrophy.
Observations:
A 4 month old infant underwent Descemet membrane endothelial keratoplasty (DMEK) for posterior polymorphous corneal dystrophy. The graft was found to be dislocated on day 5 post-operatively and an attempt to unfold the DMEK scroll and re-bubble was not successful. The patient was then treated successfully with bilateral Descemet stripping automated endothelial keratoplasty (DSAEK). At 3 years of follow-up, her visual acuity was 20/70 in the right and 20/60 in the left eye with good endothelial cell counts.
Conclusions And Importance:
and Importance: This study reports the youngest case of EKs performed at the age of 4 months in an infant. This is also the first reported case of attempted DMEK highlighting its challenges in infants. DSAEK remains a good treatment option for endothelial dysfunction secondary to posterior polymorphous corneal dystrophy in infants even after failed DMEK.
