Abstract
Purpose :
To describe the outcomes and complications of DMEK performed in children with endothelial dystrophies.
Methods :
This was a retrospective case series. Nine eyes of 5 children who underwent Descemet membrane endothelial keratoplasty (DMEK) for the primary indication of endothelial dystrophy (congenital hereditary endothelial dystrophy, n=6; posterior polymorphous corneal dystrophy, n=3) from January 2013 to December 2018 were included. Data on diagnosis, clinical and surgical details, visual acuity (VA) and complications were collected and analysed. Outcome measures included graft clarity at last follow-up, visual acuity and complications. Key modifications to the standard endothelium out, no touch DMEK technique for paediatric eyes in our series included: the use of an endoilluminator to aid visualization in cloudy corneas, careful calibration of anterior chamber (AC) fluidics, avoidance of iatrogenic lens damage in these phakic eyes with clear lens, thorough removal of host DM with confirmation using anterior segment optical coherence tomography (ASOCT) and shorter corneal wound construction to avoid interference with the graft edge. All patients had at least 1 planned examination under anaesthesia (EUA) within the first 3-5 days after surgery.
Results :
The mean age of the patients was 5.8±3.7 years and the mean follow-up duration was 10.4±2.7 months. There were no intraoperative complications. Postoperative graft detachment was present in 5 eyes, all of which underwent air rebubbling. Two eyes had technical graft failure related to graft dislocation and 1 eye had primary endothelial failure. There were no cases of graft rejection or elevated intraocular pressure. The mean logMAR VA improved from 0.88±0.22 (baseline) to 0.74±0.17 at 6 months and 0.50±0.14 at 12 months. The mean central corneal thickness improved from 1069±177μm (baseline) to 691±135μm at 6 months and 658±85μm at 12 months. The overall survival probability of the cases in our series was 66.7%.
Conclusions :
Despite the technical challenges associated with DMEK, it is a safe and viable surgical option for children with endothelial dystrophy. Modifications to standard DMEK technique are needed due to the anatomical attributes of the pediatric eye and an EUA is often necessary for a reliable assessment of graft status after surgery. Further studies are needed to examine if the indications for pediatric DMEK may be expanded.
This is a 2020 ARVO Annual Meeting abstract.