Clinical outcomes after Descemet's stripping endothelial keratoplasty using donor corneas from children younger than 3 years

Hemi-Ultrathin Descemet Stripping Automated Endothelial Keratoplasty (Hemi-UT-DSAEK) Using Pediatric Donor Corneas: A Case Series

OBJECTIVE

We sought to evaluate the clinical outcomes of hemi-UT-DSAEK grafts from the pediatric donor corneas of patients affected by Fuchs Endothelial Corneal Dystrophy (FECD).

METHODS

A prospective, interventional case series was conducted at the Ophthalmology Department of Venice Civil Hospital and the Veneto Eye Bank Foundation (Venice, Italy). Six eyes of six patients affected by FECD received large-diameter, semicircular hemi-UT-DSAEK grafts obtained from three pediatric donor corneas using the standard pull-through method. Endothelial cell density (ECD), central corneal thickness (CCT), best-corrected visual acuity (BCVA) and intraoperative and postoperative complications were recorded at different time intervals up to 12 months.

RESULTS

The average donor age was 64.6 ± 8.6 years, and the pre-operative ECD was 3266 ± 225 cells/mm2. At 12 months postoperatively, the average ECD was 1376 ± 509 cells/mm2 with a mean decrease of 56.8 ± 19.1% from the preoperative donor count. At 12 months, four out of six eyes had significantly improved and reached a BCVA of ≥20/25 (Snellen equivalent). The mean CCT significantly decreased from 788 ± 138 μm before surgery to 576 ± 30 μm at 12 months postoperatively (p < 0.01).

CONCLUSIONS

Hemi-UT-DSAEK grafts using pediatric donor corneas are surgically feasible and can provide similar clinical outcomes compared to conventional UT-DSAEK. Transplanting pediatric donor tissues with high ECD into two patients could potentially increase the donor tissue pool to treat endothelial disease.

Descemet's stripping automated endothelial keratoplasty using donor tissue from an 83-day-old infant

Purpose:

To report a case of Descemet stripping automated endothelial keratoplasty (DSAEK) combined with phacoemulsification in an adult recipient using endothelial graft from an 83-day-old infant donor.

Methods:

A corneoscleral button was obtained from an infant donor and a DSAEK graft was prepared using a microkeratome. In comparison to the standard technique of DSAEK graft preparation some modifications were made in order to avoid inadvertent perforation, as the donor cornea had a very spherical shape, probably due to the very young age of the donor. The DSAEK graft was transplanted to the left eye of a 68-year-old woman suffering from Fuchs' endothelial dystrophy. Her preoperative best-corrected visual acuity (BCVA) in that eye was 20/100 and central corneal thickness 831 μm.

Results:

An uneventful DSAEK combined with phacoemulsification was performed. The main complication noted was detachment of the peripheral part and contraction of the corneal graft, observed two months after the procedure. The implanted tissue remained centrally attached with a BCVA of 20/40, 3 years postoperatively.

Conclusion:

This case report highlights the difficulties emerging from preparation and implantation using an endothelial graft tissue from the youngest ever reported donor.

Graft detachments in endothelial keratoplasty

Graft detachment is the most common complication of endothelial keratoplasty. With the ongoing advancements in the field of endothelial keratoplasty, our understanding of risk factors of graft detachments and its management has been evolving. Various prevention measures have been described in literature including presoaking the donor graft, anterior chamber tamponade, venting incisions, sutures to prevent dislocation of graft. Management of a detached graft involves secondary interventions such as rebubbling, suturing and regrafts. In this review, we discuss graft detachment in different types of endothelial keratoplasty techniques including Descemet stripping endothelial keratoplasty, Descemet stripping automated endothelial keratoplasty and Descemet's membrane endothelial keratoplasty; with emphasis on incidence, risk factors, preventive measures and their management.

Descemet Stripping Endothelial Keratoplasty in Pediatric Patients with Congenital Hereditary Endothelial Dystrophy

PURPOSE

To report the long-term outcomes of Descemet stripping endothelial keratoplasty (DSEK) with suture-assisted donor lenticule insertion performed in different age groups for pediatric patients with congenital hereditary endothelial dystrophy (CHED).

DESIGN

Retrospective case series.

METHODS

Pediatric patients with CHED who underwent DSEK from January 2010 to January 2016 were enrolled. Patients were divided into 2 groups according to their ages: the infant group and the child group. Long-term clinical outcomes and complications were compared.

RESULTS

Thirty eyes of 16 patients were included: 19 eyes (10 patients) in the child group and 11 eyes (6 patients) in the infant group. The average duration of follow-up was 4.08 ± 1.90 years (range 2.5-8.5 years). Corneal transparency scores of the 2 groups on postoperative day 7 were not statistically different. The average postoperative best-corrected visual acuity (BCVA) in the infant group (logMAR 0.32 ± 0.11) was better than that in the child group (logMAR 0.54 ± 0.20; (P = .01). Thirty-three percent of cases in the child group and 86% of cases in the infant group had postoperative BCVA achieved or better than logMAR 0.4. Average endothelial cell loss in the child group was 31.21% ± 9.17%. Lenticule detachment occurred in 3 cases in the child group.

CONCLUSIONS

Improved visual outcomes could be achieved in infant patients with CHED after DSEK without significant complications. Suture-assisted donor lenticule insertion techniques, Descemet membrane stripping, and postoperative sedation are advocated technical points.