Descemet stripping automated endothelial keratoplasty in pediatric age group

Purpose: To report the outcomes of DSAEK surgery performed in pediatric patients. Design: Noncomparative interventional case series. Subjects and methods: All pediatric patients (age up to 16. years) undergoing Descemet automated stripping endothelial keratoplasty (DSAEK) at our Institution since January 2008 have been enrolled in a prospective study. A standard DSAEK, involving delivery of an 8.5-9.5. mm graft by Busin glide, was performed under general anesthesia in 19 eyes of 11 pediatric patients (congenital hereditary endothelial dystrophy n= 13; congenital glaucoma n= 2; posterior polymorphous dystrophy n= 2, and failed penetrating keratoplasty n= 2). Slit-lamp examination, refraction and visual acuity as well as endothelial cell density were evaluated preoperatively as well as 1, 3, 6, 12, and 18. months postoperatively. Results: All surgical procedures were uneventful. Graft detachment occurred in 4 cases and was managed successfully with repeat air injection. All corneas cleared within a week from surgery. Follow-up was 3-18. months. At last follow-up examination, best-corrected visual acuity (BCVA) was better than 20/40 in 8 of the 13 cases of patients old enough to assess vision. A graft rejection episode was seen in 1 case within 3. months from surgery but was reverted with steroidal treatment. No graft failures were observed. Conclusions: DSAEK is an appropriate surgical intervention for children with corneal endothelial failure. In contrast to penetrating keratoplasty (PK), DSAEK is performed under " closed system" conditions, thus minimizing intraoperative risks. Finally, healing is much faster than with PK and all sutures can be removed within 2-4. weeks from surgery, thus allowing fast visual recovery and prompt starting of amblyopia treatment. © 2012 King Saud University.