Outcomes of Endothelial keratoplasty in Children with Endothelial dystrophies
Authors: Manokamna Agarwal 1, Jyh Haur Woo2, Kamiar Mireskandari1, David S. Rootman1, Asim Ali1. 1The hospital for Sick Children, 2Singapore National Eye Centre.
Author Disclosures: M. Agarwal: None. J. Woo: None. K. Mireskandari: None. D.S. Rootman: None. A. Ali: None.
Abstract Body:
Purpose: To report long-term outcomes of Descemet stripping automated endothelial keratoplasty (DSAEK) andDescemet membrane endothelial keratoplasty (DMEK) in children with endothelial dystrophies.
Study Design: A retrospective case series.
Methods: The study included 16 patients under 10 years of age undergoing either DSAEK (n=8) or DMEK (n=8) for the primary indication of corneal endothelial dystrophy from January 2018 to March 2021. Indications for DSAEK included congenital hereditary endothelial dystrophy (CHED) (n=7) and (posterior polymorphous corneal dystrophy) (PPCD) (n=1). Indications for DMEK included CHED (n=5) and PPCD (n=3). Post-operative outcomes including graft detachment, graft clarity, rate of re-bubbling, visual acuity (VA), complications and endothelial cell count (ECC) were analyzed.
Results: The mean age of patients for DSAEK and DMEK was 3.8±3.5 years (4 months - 9.7 years) and 5.8±3.7 years (1.8 - 8.3 years), with mean follow-up of 3.3±3.1 and 3.8±1.4 years respectively. Iris prolapse (n=1) and lenticular touch (n=1) were noted in DSAEK, whereas no intraoperative complications were encountered in DMEK. No graft detachment or re-bubbling was noted with DSAEK. In DMEK, postoperative graft detachment was present in 5 of 8 eYes, all of which underwent air re-bubbling (62.5%). All grafts in the DSAEK group remained clear till the last follow-up visit. There were no cases of graft rejection or elevated intraocular pressure in either DSAEK or DMEK. Of the 8 patients undergoing DMEK, 2 eyes had technical graft failure related to graft dislocation and 1 eye had primary endothelial failure. These patients were excluded from the final post-operative analysis for VA and ECC. The rest of the DMEK grafts remained clear (n=5). The mean logMAR VA improved from 0.95±0.23 to 0.62±0.17 for DSAEK, and 0.88±0.22 to 0.64±0.06 for DMEK. Mean ECC at last follow-up was 1466.6±320.5 and 894.5±222.5 for DSAEK and DMEK, respectively. The overall survival probability of the cases in our series was 100% and 62.5% in DSAEK and DMEK, respectively.
Conclusions: We observe less graft detachment and need for re-bubbling in DSAEK over DMEK. The endothelial cell count at last visit were noted to be higher with DSAEK compared to DMEK. The lower rate of post-operative complications with DSAEK over DMEK was likely associated with an improved probability of success of DSAEK in this cohort of children less than 10 years of age with corneal endothelial dystrophies.
