Descemet's membrane endothelial keratoplasty (DMEK) in infants with congenital endothelial dysfunction: intraoperative OCT-assisted surgery

Session Details

Session Title: Moderated Poster Session: Cornea

Venue: Poster Village: Pod 2

First Author: : G.Martin FRANCE

Co Author(s): :    P. Lebranchu   P. Dureau   I. Cochereau   J. Devys   G. Caputo   E. Gabison        

Abstract Details

Purpose:

In the management of endothelial dysfunctions in adults, Descemet Membrane Endothelial Keratoplasty (DMEK) and Descemet Stripping Automated Endothelial Keratoplasty (DSAEK) have shown better outcomes than penetrating keratoplasty (PK) regarding visual acuity (VA), intraoperative complications, graft rejection and quality of life. In children, the high prevalence of graft rejection and amblyopia after PK has been well established. Some publications recently reported DSAEK in Congenital Hereditary Endothelial Dystrophy (CHED) and Posterior Polymorphous Congenital Dystrophy (PPCD), but no successful DMEK in infants has been yet reported. We report the surgical and anesthetic particularities of DMEK in infants with congenital endothelial dysfunction.

Setting:

We retrospectively reviewed the cases of two infants with bilateral congenital corneal edema, who underwent a DMEK in one or both eyes, in the Ophthalmology Department of Fondation Ophtalmologique A. de Rothschild.

Methods:

The pre-operative and post-operative follow up relied on the corneal clearness, the refractive error and the ultrasound (US) pachymetry. If not measurable with US, the corneal thickness was estimated with the anterior segment optical coherence tomography (AS-OCT).

Results:

Case 1 underwent DMEK in OS at the age of 2 years. The VA was 20/63 with +1.75 (+2 at 170°) and a pachymetry of 572 µm, 2 years after surgery. Case 2 had a pachymetry of 1100 µm OU, leading to a DMEK in OR at the age of 12 months. Two months after surgery, the refractive error was +7 (+1.25 at 170°) with a pachymetry of 608 µm. A DMEK was performed in OS at 14 months of age, with decrease of edema one month after surgery. Intraoperative AS-OCT allowed a correct graft positioning despite the corneal opacity.

Conclusions:

These first cases of successful DMEK in infants show the feasibility of this technique regardless of the age. Intraoperative AS-OCT appeared to be very helpful to ensure a good visualization and orientation of the graft, through a dense corneal opacity. Compared to KP, a better visual prognosis is expected, considering the quicker recovery, with smaller incisions and less astigmatism, and a lower risk of graft rejection or wound dehiscence.

Financial Disclosure:

None