DSEK offers promise for pediatric congenital hereditary endothelial dystrophy

This study reports the long-term outcomes of Descemet stripping endothelial keratoplasty (DSEK) in children with congenital hereditary endothelial dystrophy (CHED).

Study design

This single-center, retrospective cohort study enrolled 16 pediatric patients (30 eyes). Patients under the age of 1 were assigned to the infant group (6 patients, 11 eyes) while the remainder were assigned to the child group (10 patients, 19 eyes). All eyes underwent DSEK for CHED and were evaluated at 12-months postoperatively.

Outcomes

Both groups experienced comparable improvements in corneal transparency. The standardized suture pull-through technique did not result in lenticular changes in any patient. Although BCVA improved in both groups, the infant group had statistically better vision than the child group (0.32 vs. 0.54 logMAR; P=0.01).

Limitations

Although 3 eyes detached in the child group, they all occurred early in the study, suggesting a learning curve effect and a lack of postoperative sedation which was provided later in the study. While the endothelial cell loss rate in the child group was similar to what has been observed in prior studies, the infant group was not evaluated due to lack of cooperation and a short follow-up period.

Clinical significance

Descemet stripping endothelial keratoplasty for endothelial disease in children shows promise as a modality to reduce intraoperative and postoperative risks associated with PK. It can be performed in infants with limited complications and may potentially lead to better visual outcomes through early intervention using pediatric-specific modifications.