PEDIATRIC ENDOTHELIAL KERATOPLASTY: CHALLENGES AND OUTCOME- A PROSPECTIVE STUDY AT A TERTIARY CARE EYE CENTRE

Col (DR) Jaya Kaushik, Maj (DR) Ankita Singh, Col (DR) Alok Sati, Brig (DR) Poninder Kumar

Abstract


Purpose: The purpose of this article is to highlight the challenges faced during non-descemet stripping endothelial keratoplasty (n-DSEK) and the
outcome in pediatric patients.
METHODS
Design: Eight eyes of six children with corneal decompensation [Congenital hereditary endothelial dystrophy (05), failed Penetrating
Keratoplasty (02) and toxic endothelitis (01)] who underwent n-DSEK, were prospectively followed for visual acuity, corneal thickness and
complications. Intra operative challenges encountered during n-DSEK were also evaluated. All the patients were evaluated pre-operatively under
slit-lamp. Refraction and initial visual acuity was documented. Postoperative follow up was done at day 1, 7, 30, 12 weeks and at 6 months.
Subsequent, follow up was done at 12 and 18 months postoperatively.
Results: All patients completed 6 months of follow-up. Mean visual acuity (VA) in LogMar at 3 months and 6 months was 0.73 & 0.43 respectively.
VA improved significantly and corneal thickness also reduced at 3 (p<0.05.) & 6 (p<0.05) months post-operatively. 2 out of 8 eyes had lenticule
dislocation at 7th postoperative day . They were managed successfully by re-bubbling. Intraoperative challenges faced were: while making
incision, descematorrhexis, peripheral iridotomy, sheet glide insertion and air tamponade and were managed by using cohesive viscoelastic, deeper
anesthesia and multiple suture placement respectively.
Conclusions: Inspite of multiple intra operative challenges the n-DSEK seems to be a promising surgical procedure in children with corneal
endothelial decompensation.


Keywords


Pediatric Endothelial Keratoplasty, DSEK, Corneal endothelial decompensation

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