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Updated: Oct 15, 2025
Corneal Donor Tissue Preparation for Descemet's Membrane Endothelial Keratoplasty
Published on: September 17, 2014
Pediatric endothelial keratoplasty: a systematic review and individual participant data meta-analysis
Masomeh Mohebbi1, Mohammad Mehrpour1, Amin Dehghani Sanij2
1Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Qazvin square, South Karegar Street, 1336616351, Tehran, Iran.
Insights
Endothelial keratoplasty (EK) is a feasible surgical option for pediatric corneal endothelial dysfunction, offering acceptable visual outcomes despite technical challenges. This review highlights its effectiveness in young patients.
Area of Science:
- Ophthalmology
- Surgical Innovation
- Pediatric Eye Care
Background:
- Endothelial keratoplasty (EK) is increasingly considered for pediatric isolated corneal endothelial dysfunction.
- This systematic review evaluates EK's advantages, disadvantages, technical challenges, and outcomes in pediatric patients.
Purpose of the Study:
- To systematically review the current evidence on endothelial keratoplasty in pediatric patients.
- To assess the feasibility, outcomes, and challenges of EK in managing pediatric corneal endothelial dysfunction.
Main Methods:
- A comprehensive literature search was conducted in PubMed, Embase, Scopus, and Cochrane databases.
- Relevant English literature on pediatric EK was identified and data were pooled for meta-analysis.
Main Results:
- 35 articles involving 154 eyes (107 patients) undergoing EK were analyzed; Descemet's stripping automated endothelial keratoplasty (DSAEK) was most common.
- Congenital hereditary endothelial dystrophy (CHED) was the primary indication for pediatric DSAEK.
- Postoperative best-corrected visual acuity (BCVA) improved significantly, though graft dislocation was the most frequent complication.
Conclusions:
- Endothelial keratoplasty procedures are feasible in pediatric patients with corneal endothelial dysfunction.
- EK offers acceptable visual and anatomical outcomes, despite some technical challenges specific to pediatric anatomy.
Background:
Recently, endothelial keratoplasty (EK) has been increasingly considered the first intervention in pediatrics with isolated corneal endothelial dysfunction. This systematic review aims to investigate the current evidence about the advantages, disadvantages, technical challenges, and clinical outcomes of EK in the pediatric group.
Method:
All the English literature relevant to pediatric EK was searched in PubMed, Embase, Scopus, and Cochrane databases with appropriate keywords. Relevant data were pooled to conduct an individual participant data meta-analysis.
Results:
Of 1646 articles found initially, 35 articles were finally eligible to be included in our study. A total of 154 eyes of 107 patients underwent Descemet's stripping automated endothelial keratoplasty (DSAEK). Congenital hereditary endothelial dystrophy (CHED) was the most reported indication for pediatric DSAEK (108 eyes). Descemet's membrane endothelial keratoplasty (DMEK) was performed in 2 eyes of 2 cases, one with PPCD and another one in a patient with Kearns-Sayre syndrome. Owing to some specific anatomical and physiological pediatric characteristics, some modifications in a standard procedure were suggested. The average follow-up period was 23.80 ± 20.18 months (3 months to 8.5 years). Seventy-six eyes who had a mean best-corrected visual acuity (BCVA) of 1.36 ± 0.70 (0.49 to 3) logMAR preoperatively found mean BCVA of 0.51 ± 0.33 (0.04 to 2) logMAR postoperatively. Graft dislocation was the most reported complication (26 eyes). The rate of other complications was low. Endothelial cell loss was reported from 8.3 to 63.7% after pediatric EK with follow-up duration from 3 months to 8.3 years.
Conclusion:
EK procedures, despite some technical challenges, are feasible surgical techniques with acceptable visual and anatomical outcomes in the management of pediatrics with corneal endothelial dysfunction and minimal stromal involvement.
