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Corneal Donor Tissue Preparation for Descemet's Membrane Endothelial Keratoplasty
Published on: September 17, 2014
Descemet Stripping Automated Endothelial Keratoplasty in Pediatric Age Group: A Decade of Our Experience
Muralidhar Ramappa1,2,3, Ashik Mohamed1,4, Divya S Ramya Achanta1,2,3
1Centre for Rare Eye Diseases and Ocular Genetics, L V Prasad Eye Institute, Hyderabad, India.
Insights
Descemet stripping automated endothelial keratoplasty (DSAEK) is a safe and effective treatment for corneal endothelial disorders in children. This procedure significantly improves vision and maintains graft clarity in the pediatric population.
Area of Science:
- Ophthalmology
- Corneal Surgery
- Pediatric Eye Care
Background:
- Corneal endothelial dysfunction in children presents unique management challenges.
- Endothelial keratoplasty techniques aim to restore corneal clarity and visual function.
- Descemet stripping automated endothelial keratoplasty (DSAEK) is a less invasive option compared to penetrating keratoplasty.
Purpose of the Study:
- To evaluate the outcomes of Descemet stripping automated endothelial keratoplasty (DSAEK) in pediatric patients.
- To assess the safety and efficacy of DSAEK for managing corneal endothelial disorders in children under 14 years old.
Main Methods:
- Retrospective review of 180 DSAEK procedures performed between 2008 and 2020 on 111 children.
- Analysis included etiology of corneal decompensation, visual acuity, surgical details, and reinterventions.
- Median follow-up was 2.5 years.
Main Results:
- 86.2% of grafts remained clear at a median follow-up of 2.5 years.
- Best-corrected visual acuity significantly improved (P < 0.0001).
- Long-term graft survival rates were high, with significant risk factors for failure identified.
Conclusions:
- DSAEK is a safe and effective surgical option for pediatric corneal endothelial disorders.
- The procedure offers significant visual rehabilitation in young patients.
- DSAEK demonstrates favorable long-term graft survival in the pediatric population.
Purpose:
This study was to report the outcomes of Descemet stripping automated endothelial keratoplasty (DSAEK) in managing corneal endothelial disorders in children less than 14 years of age.
Methods:
Medical records of 180 DSAEK performed, between 2008 and 2020, on 167 eyes of 111 children who had a visually significant endothelial dysfunction were retrospectively reviewed for the primary etiology of corneal decompensation, time of the onset and duration of cloudiness, preoperative visual acuity, the technique of endothelial keratoplasty, surgical modifications, and reintervention.
Results:
Median age at surgical intervention was 7.9 years (interquartile range, 5.2-11.2 years). At a median postinterventional follow-up of 2.5 years (interquartile range, 0.9-3.4 years), 86.2% (144 of 167 eyes, 95% confidence interval 79.9%-90.1%) maintained a clear graft. Median best-corrected visual acuity (logarithm of the minimum angle of resolution) improved from 1.45 ± 0.70 preoperatively to 0.90 ± 0.06 at the last follow-up visit (P < 0.0001). The cumulative overall long-term graft survival was 92.7%, 86.5%, and 77.7% at 1, 3, and 7 years, respectively. Cox proportional hazards regression analysis showed that the indication for DSAEK (P = 0.007; hazards ratio: 2.17 ± 0.62), age at surgery (P = 0.02; hazards ratio: 0.87 ± 0.05), and any subsequent intervention after DSAEK (P = 0.003; hazards ratio: 0.11 ± 0.08) were significant risk factors for DSAEK failure. The endothelial cell loss was 40.1% at 6 months, 45.4% at 1 year, 55.2% at 5 years, and 61.9% at 7 years.
Conclusions:
DSAEK is a safe and effective surgical strategy in managing endothelial disorders among the pediatric age group.
