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Corneal Donor Tissue Preparation for Descemet's Membrane Endothelial Keratoplasty
Published on: September 17, 2014
Pediatric Descemet Membrane Endothelial Keratoplasty
Bhaskar Srinivasan1, Manokamna Agarwal2, Geetha Iyer2
1From the Department of Cornea and Refractive Surgery, Sankara Nethralaya, Medical Research Foundation, Chennai, Tamil Nadu, India..
Insights
Descemet membrane endothelial keratoplasty (DMEK) shows promising results in pediatric patients older than 6 years. This technique improved vision and corneal clarity in 80% of cases, indicating its viability for endothelial dysfunction.
Area of Science:
- Ophthalmology
- Corneal Surgery
Background:
- Endothelial dysfunction in pediatric patients presents unique challenges for visual rehabilitation.
- Descemet membrane endothelial keratoplasty (DMEK) is a modern lamellar keratoplasty technique offering potential advantages over traditional endothelial keratoplasty.
- Limited data exists on the efficacy and safety of DMEK specifically in the pediatric population.
Purpose of the Study:
- To evaluate the surgical technique and clinical outcomes of Descemet membrane endothelial keratoplasty (DMEK) in pediatric patients aged 6 years and older.
- To assess visual acuity, corneal transparency, pachymetry, and complication rates following DMEK in this age group.
Main Methods:
- A retrospective case series involving 5 eyes of pediatric patients under 15 years old with endothelial dysfunction undergoing DMEK.
- Surgical techniques included Descemet stripping endothelial keratoplasty (DSEK) and non-Descemet stripping endothelial keratoplasty (NDSEK).
- Outcomes measured included graft attachment, visual acuity, corneal clarity, pachymetry, and complications, with primary graft failure defined as persistent corneal edema.
Main Results:
- Five pediatric eyes (all male, mean age 9.2 years) underwent DMEK.
- Postoperative visual acuity significantly improved from 1.93 logMAR to 0.98 logMAR (P=.03).
- Anatomic success with a clearer cornea and reduced pachymetry was achieved in 80% of eyes (4/5), with a mean pachymetry reduction from 1094.5 µm to 619.25 µm (P=.03). One eye experienced primary graft failure, and 40% required rebubbling.
Conclusions:
- Descemet membrane endothelial keratoplasty (DMEK) is technically challenging in pediatric eyes but demonstrates encouraging early outcomes.
- The procedure is a viable surgical option for pediatric patients suffering from endothelial failure, offering significant visual and structural improvements.
- Further research with larger cohorts is warranted to solidify the long-term efficacy and safety profile of DMEK in pediatric populations.
Purpose:
To report the technique and outcome of Descemet membrane endothelial keratoplasty (DMEK) in pediatric patients older than 6 years of age.
Design:
Institutional interventional retrospective case series.
Methods:
This study included 5 eyes of patients less than 15 years of age with endothelial dysfunction who underwent DMEK. Three eyes had Descemet stripping done of the same size as the donor graft. Two eyes underwent non-Descemet stripping endothelial keratoplasty. Attachment of DMEK scroll and improvement in corneal clarity, vision, pachymetry, and intraoperative or postoperative complication was noted. We defined primary graft failure as nonclearing corneal edema despite a well-attached lenticule on anterior segment optical coherence tomography.
Results:
A total of 5 eyes of 5 children (all male) with a mean (± standard deviation) age of 9.2 ± 3.42 years underwent DMEK. The mean preoperative visual acuity of 1.93 ± 0.25 logMAR units improved postoperatively to 0.98 ± 0.29 (95% confidence interval, P = .03). Anatomic success (well-attached scroll with a more transparent cornea with a decrease in pachymetry) was seen in 4 of 5 eyes (80%). One eye had a primary donor failure. Two out of the 5 eyes (40%) required rebubbling. The mean pachymetry in eyes with successful procedure reduced from 1094.5 ± 101.5 µm to 619.25 ± 150.3 µm (P = .03).
Conclusions:
Although DMEK in pediatric eyes is challenging, the early results are encouraging, and it is a viable option in pediatric patients with endothelial failure.
