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Updated: Nov 30, 2025
Corneal Donor Tissue Preparation for Descemet's Membrane Endothelial Keratoplasty
Published on: September 17, 2014
Bilateral Descemet Membrane Endothelial Keratoplasty in an Infant With Congenital Hereditary Endothelial Dystrophy
Frances Wu1, Julius T Oatts1, Julie M Schallhorn1,2
1Department of Ophthalmology, University of California, San Francisco, San Francisco, CA; and.
Insights
Descemet membrane endothelial keratoplasty (DMEK) is feasible in infants for congenital hereditary endothelial dystrophy. This infant showed improved vision and corneal transparency with no complications after DMEK.
Area of Science:
- Ophthalmology
- Pediatric Ophthalmology
- Corneal Surgery
Background:
- Congenital hereditary endothelial dystrophy (CHED) is a rare condition affecting corneal clarity in infants.
- Descemet membrane endothelial keratoplasty (DMEK) is a type of corneal transplant typically performed in adults.
- Limited data exists on DMEK outcomes in infants.
Observation:
- A 3-month-old infant with CHED underwent unilateral DMEK, initially complicated by graft issues.
- Successful bilateral DMEK was subsequently performed.
- Postoperative assessment included visual acuity, corneal thickness (pachymetry), and transparency.
Findings:
- Following bilateral DMEK, the infant's nystagmus resolved.
- Visual acuity improved significantly from 20/2000 to 20/270 in both eyes.
- Corneal transparency improved, and pachymetry normalized, with no adverse events observed within 3 months.
Implications:
- DMEK is a viable treatment option for corneal endothelial disorders in infants.
- Infant DMEK may offer better visual outcomes and reduced rejection risk compared to other transplant methods.
- Further research is warranted to confirm these findings in a larger infant cohort.
Purpose:
Descemet membrane endothelial keratoplasty (DMEK) has been reported in children but not in infants. We evaluate the outcomes and complications of DMEK for an infant with congenital hereditary endothelial dystrophy.
Methods:
A 3-month-old male infant with congenital hereditary endothelial dystrophy underwent unilateral DMEK, which was complicated by incomplete graft unfurling. Bilateral DMEK was then performed successfully. The visual acuity, pachymetry, corneal transparency, and complications were assessed over 3 months of follow-up.
Results:
At 3 months postoperatively, the nystagmus had resolved and visual acuity improved from 20/2000 to 20/270 in each eye. Pachymetry, which had been unmeasurable preoperatively, was 695 μm in the right eye and 678 μm in the left eye. On examination, there was improvement in corneal transparency bilaterally. There were no postoperative complications.
Conclusions:
We demonstrate that DMEK is feasible in infants and propose that it should be considered in the treatment of corneal endothelial disorders of infancy. In theory, DMEK might confer improved visual potential and lower risk for rejection compared with other corneal transplantation techniques, although further studies in this age group are needed.
