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

Yang, Fan; Hong, Jing; Xiao, Gege; Feng, Yun; Peng, Rongmei; Wang, Minshu; Qu, Hongqiang

doi:10.1016/j.ajo.2019.08.010

Cited by 34 publications

(45 citation statements)

References 30 publications

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“…The endothelial loss at the final follow-up compared to the baseline was 36.2% (range, 14.7 to 49.3%), which was comparable to other studies in the literature. 2 , 18 , 36 , 37 Thirty-five eyes (35/39; 89.7%) developed clear cornea at the four-week follow-up and all the eyes had clear cornea at six week follow-up period in our study which was X relatively long compared to other studies. 2 This could again be attributed to the relatively thicker baseline corneas in our eyes compared to the other studies.…”

Section: Discussioncontrasting

confidence: 45%

Microscope Integrated Optical Coherence Tomography Guided Descemet Stripping Automated Endothelial Keratoplasty in Congenital Hereditary Endothelial Dystrophy

Asif

Bafna

Sharma

et al. 2021

OPTH

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Purpose: To describe the outcomes of descemet stripping automated endothelial keratoplasty (DSAEK) in congenital hereditary endothelial dystrophy (CHED) and to evaluate the role of microscope integrated optical coherence tomography (Mi-OCT) during the surgery. Design: Retrospective data analysis. Methods: A retrospective study from the medical records of all those patients who were diagnosed with CHED and underwent DSAEK at our centre from 2015 were evaluated. All patients underwent Mi-OCT-guided standard DSAEK procedure. Intra-operative difficulties, visual outcomes and graft survival were recorded. Results: A total of 48 eyes of 29 patients with a mean age of 9.87 ± 8.2 years and mean follow-up of 17.3 months were evaluated. Thirty-nine eyes underwent primary DSAEK and 9 eyes underwent PKP. Three eyes who underwent PKP had failed graft for which they underwent DSAEK. The mean preoperative Snellen's visual acuity was 1.71 ± 0.66 and the mean preoperative central corneal thickness was 1.10 ± 0.174 mm. Intraoperatively, all the grafts were attached which was confirmed using Mi-OCT. Graft detachment was seen in the immediate postoperative period in 10.4% (4 eyes) of primary DSAEK, out of which DM scoring was not performed in 2 eyes. Following DSAEK, cornea cleared at four-week follow-up in 89.7% eyes and in all the eyes the cornea cleared at six-week follow-up. Conclusion: Primary DSAEK could be a preferred option over PKP for CHED with early presentation and in those eyes with failed primary PKP. Mi-OCT is a very useful tool in these eyes for various intraoperative procedures, thereby improving the outcomes of the procedure.

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Section: Discussioncontrasting

confidence: 45%

Microscope Integrated Optical Coherence Tomography Guided Descemet Stripping Automated Endothelial Keratoplasty in Congenital Hereditary Endothelial Dystrophy

Asif

Bafna

Sharma

et al. 2021

OPTH

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“…In addition to their own or their guardians' wishes, patients with severe edematous corneas or extremely shallow anterior chambers underwent PK, while the others underwent DSAEK. Referring to the standard procedures, PK (4 grafts, 3 patients) and DSAEK (8 grafts, 5 patients) were performed to replace the full-thickness edematous cornea and the diseased corneal endothelium, respectively [14,15]. Synechiolysis and special considerations for PK.…”

Section: Surgical Techniquementioning

confidence: 99%

“…A donor lenticule ranging from 120 to 150 µm in thickness was recommended. Removing viscoelastic, the donor lenticule was inserted into the anterior chamber with the suture pull-through insertion technique [14,15] and unfolded in balanced salt solution (BSS, Alcon, Fort Worth, TX, USA). A lenticule-sized bubble was injected from the paracentesis incision, and the donor lenticule was positioned and centered with a roller.…”

Section: Surgical Techniquementioning

confidence: 99%

The Clinical Outcomes of Keratoplasty in Irreversible Corneal Decompensation Secondary to Axenfeld-Rieger Syndrome

Hong

Xiao

et al. 2021

Preprint

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Porpose To evaluate the clinical outcomes of penetrating keratoplasty (PK) and Descemet’s stripping automated endothelial keratoplasty (DSAEK) in eyes with irreversible corneal decompensation secondary to Axenfeld-Rieger syndrome (ARS).Methods In this retrospective case series, a total of 4 eyes undergoing PK and 7 eyes undergoing DSAEK, including 1 eye requiring 1 repeat DEASK, between 2014 and 2021 were enrolled. Postoperative complications, graft survival, glaucoma treatment before and after keratoplasty, visual outcomes, and endothelial cell density were recorded.Results The mean follow-up duration was 33.4 ± 16.8 months. Before keratoplasty, the mean BCVA was 2.0 ± 0.4 LogMAR, and the mean IOP was 21.6 ± 8.1 mmHg. 63.6% of eyes (7/11) received glaucoma treatment, including 5 eyes with glaucoma surgeries. After keratoplasty, 27.3% of eyes (3/11) exhibited secondary graft failure. The mean BCVA reached a maximum of 0.7 ± 0.5 LogMAR at 8.9 ± 7.5 months, with no significant difference between the PK and DSAEK groups (P1=1.00, P2=0.12). Four eyes with previous glaucoma surgeries exhibited markedly high IOP. 72.7% of eyes (8/11) required additional glaucoma treatments. The mean endothelial cell loss (ECL) rates at 1, 6, 12 and 24 months were 43%, 49%, 63% and 54%, respectively, with no significant difference between the PK and DSAEK groups (P1=0.64, P2=1.00, P3=0.57, and P4=0.44).Conclusion Both PK and DSAEK can successfully treat corneal decompensation secondary to ARS, resulting in similar outcomes with regard to IOP control, BCVA and ECL. IOP control is essential for postoperative management, especially for eyes with previous glaucoma surgeries.

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“…This was the case in Yang and colleagues' recent series, where the youngest patient was 6 months of age. 12 It is also worth noting that the majority of patients reported by Areaux and colleagues 3 had Peters' anomaly, for which DSEK may not be appropriate. 13 Thus, PK for infants may be with us for some time yet.…”

mentioning

confidence: 96%

“…Recently, a modified DSEK technique has been shown to be feasible and safe in a series of 6 infants with CHED. 12 When the cornea is opaque, surgical manipulation within the cramped phakic infant anterior chamber is a daunting prospect. Rather than risking lens damage, surgeons may be tempted to delay this surgery until the second half of the first year when the eye is a little larger rather than operating as early as the infant cataract guidelines would recommend.…”

mentioning

confidence: 99%

Keratoplasty in infancy: how early is early?

Lyons

2020

Journal of American Association for Pediatric Ophthalmology and

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

Cited by 34 publications

References 30 publications

Microscope Integrated Optical Coherence Tomography Guided Descemet Stripping Automated Endothelial Keratoplasty in Congenital Hereditary Endothelial Dystrophy

Microscope Integrated Optical Coherence Tomography Guided Descemet Stripping Automated Endothelial Keratoplasty in Congenital Hereditary Endothelial Dystrophy

The Clinical Outcomes of Keratoplasty in Irreversible Corneal Decompensation Secondary to Axenfeld-Rieger Syndrome

Keratoplasty in infancy: how early is early?

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