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Outcomes of Descemet-Stripping Automated Endothelial Keratoplasty in Congenital Hereditary Endothelial Dystrophy

Mohebbi, Masoomeh, M.D.; Nabavi, Amin, M.D.; Fadakar, Kaveh, M.D.; Hashemi, Hassan, M.D.

doi: 10.1097/ICL.0000000000000604
Article: PDF Only

Objectives: To evaluate the outcomes and complications of Descemet-stripping automated endothelial keratoplasty (DSAEK) in children with congenital hereditary endothelial dystrophy (CHED).

Methods: Eighteen eyes from 10 children with CHED who underwent standard phakic DSAEK were enrolled in this retrospective interventional case series. Medical records including slit-lamp biomicroscopy, cycloplegic refraction, visual acuity, and measurements of central corneal thickness, corneal topography, and endothelial cell density were evaluated. All complications were recorded.

Results: The mean age of cases was 8.1±4.2 (range: 3–16) years at the time of surgery. Descemet-stripping automated endothelial keratoplasty was performed successfully in all eyes, which survived in 16/18 (88.9%) of cases during a median follow-up period of 38 (range 19–64) months. In patients with clear graft, best-corrected visual acuity was improved to a range of 20/100 to 20/40 and improved to fix and follow in one younger child. Endothelial cell density decreased by an average of 42.1%, comparing baseline and 6-month follow-up and was relatively stable thereafter. A marked flattening of the anterior corneal curvature (mean change of anterior K reading: +2.56±3.14 diopters) was observed after DSAEK. The only major complication in patients with clear graft was intraocular pressure elevation in 61.1% of the eyes, which was easily controlled with one antiglaucoma medication. None of the eyes developed cataract.

Conclusion: Descemet-stripping automated endothelial keratoplasty is a safe and successful procedure in children with an acceptable graft survival in a mid-term follow-up period. A marked hyperopic shift could occur after DSAEK in children with CHED.

Eye Research Center (M.M., A.N., K.F.), Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran; and Noor Ophthalmology Research Center (H.H.), Noor Eye Hospital, Tehran, Iran.

Address correspondence to Hassan Hashemi, M.D., Noor Eye Hospital, 96 Esfandiar Blvd, Valil'asr Avenue, Tehran 19686, Iran; e-mail:

The authors have no conflicts of interest to disclose.

Supported by vice chancellery of research of Tehran University of Medical Sciences.

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Accepted February 26, 2019

© 2019 Contact Lens Association of Ophthalmologists, Inc.