Abstract
Background
Recently, endothelial keratoplasty (EK) has been increasingly considered the first intervention in pediatrics with isolated corneal endothelial dysfunction. This systematic review aims to investigate the current evidence about the advantages, disadvantages, technical challenges, and clinical outcomes of EK in the pediatric group.
Method
All the English literature relevant to pediatric EK was searched in PubMed, Embase, Scopus, and Cochrane databases with appropriate keywords. Relevant data were pooled to conduct an individual participant data meta-analysis.
Results
Of 1646 articles found initially, 35 articles were finally eligible to be included in our study. A total of 154 eyes of 107 patients underwent Descemet’s strip** automated endothelial keratoplasty (DSAEK). Congenital hereditary endothelial dystrophy (CHED) was the most reported indication for pediatric DSAEK (108 eyes). Descemet’s membrane endothelial keratoplasty (DMEK) was performed in 2 eyes of 2 cases, one with PPCD and another one in a patient with Kearns–Sayre syndrome. Owing to some specific anatomical and physiological pediatric characteristics, some modifications in a standard procedure were suggested. The average follow-up period was 23.80 ± 20.18 months (3 months to 8.5 years). Seventy-six eyes who had a mean best-corrected visual acuity (BCVA) of 1.36 ± 0.70 (0.49 to 3) logMAR preoperatively found mean BCVA of 0.51 ± 0.33 (0.04 to 2) logMAR postoperatively. Graft dislocation was the most reported complication (26 eyes). The rate of other complications was low. Endothelial cell loss was reported from 8.3 to 63.7% after pediatric EK with follow-up duration from 3 months to 8.3 years.
Conclusion
EK procedures, despite some technical challenges, are feasible surgical techniques with acceptable visual and anatomical outcomes in the management of pediatrics with corneal endothelial dysfunction and minimal stromal involvement.
Similar content being viewed by others
Data availability
Available per request (data transparency).
References
Anwar HM, El-Danasoury A (2014) Endothelial keratoplasty in children. Curr Opin Ophthalmol 25(4):340–6. https://doi.org/10.1097/ICU.0000000000000063
Sharma B, Priyadarshini S, Chaurasia S, Das S (2018) Recent advances in paediatric keratoplasty. Expert Rev Ophthalmol 13(1):1–10. https://doi.org/10.1080/17469899.2018.1429266
Fung SSM, Ali A, Mireskandari K (2017) Pediatric corneal transplantation—where are we heading? Curr Ophthalmol Rep 5(1):23–37. https://doi.org/10.1007/s40135-017-0126-3
Trief D, Marquezan MC, Rapuano CJ, Prescott CR (2017) Pediatric corneal transplants. Curr Opin Ophthalmol 28(5):477–484. https://doi.org/10.1097/ICU.0000000000000393
Mittal V, Mittal R (2014) Challenges in pediatric endothelial keratoplasty. Indian J Ophthalmol 62(2):251–254. https://doi.org/10.4103/0301-4738.128638
Medsinge A, Nischal KK (2013) Paediatric keratoplasty: choices and conundrums. Br J Ophthalmol 97(10):1225–1227. https://doi.org/10.1136/bjophthalmol-2013-303469
Moher D, Liberati A, Tetzlaff J, Altman DG, Prisma Group (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 6(7):e1000097. https://doi.org/10.1371/journal.pmed.1000097
Tierney JF SL, Clarke M (2021) Chapter 26: Individual participant data. In: Higgins JPT, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, Welch VA (editors). Cochrane Handbook for Systematic Reviews of Interventions version 6.2. Cochrane, 2021. Available from www.training.cochrane.org/handbook. https://training.cochrane.org/handbook/current/chapter-26 .Accessed 6 Oct 2021
Colby K (2008) Changing times for pediatric keratoplasty. J AAPOS 12(3):223–224. https://doi.org/10.1016/j.jaapos.2008.05.001
Panahi-Bazaz M, Sharifipour F, Malekahmadi M (2014) Modified Descemet’s strip** automated endothelial keratoplasty for congenital hereditary endothelial dystrophy. J Ophthalmic Vis Res 9(4):522–525. https://doi.org/10.4103/2008-322X.150836
Mittal V, Mittal R, Sangwan VS (2011) Successful Descemet strip** endothelial keratoplasty in congenital hereditary endothelial dystrophy. Cornea 30(3):354–356. https://doi.org/10.1097/ICO.0b013e3181e8441a
Jastaneiah SS (2012) Descemet’s strip**-automated endothelial keratoplasty for traumatic aniridia and aphakia. Case Rep Ophthalmol Med 2012:982657. https://doi.org/10.1155/2012/982657
Yang F, Hong J, ** endothelial keratoplasty in pediatric patients with congenital hereditary endothelial dystrophy. Am J Ophthalmol 209:132–140. https://doi.org/10.1016/j.ajo.2019.08.010
Mohebbi M, Nabavi A, Fadakar K, Hashemi H (2020) Outcomes of Descemet-strip** automated endothelial keratoplasty in congenital hereditary endothelial dystrophy. Eye Contact Lens 46(1):57–62. https://doi.org/10.1097/ICL.0000000000000604
Zhu AY, Prescott CR (2019) Recent surgical trends in pediatric corneal transplantation: a 13-year review. Cornea 38(5):546–552. https://doi.org/10.1097/ICO.0000000000001900
Vadhul R, Halbach CS, Areaux RG Jr, Berry S, Hou JH (2019) Endothelial dysfunction in a child with Pearson marrow-pancreas syndrome managed with Descemet strip** automated endothelial keratoplasty using a suture pull-through technique. Digit J Ophthalmol DJO 25(4):59–64. https://doi.org/10.5693/djo.02.2019.09.001
Rishi E, Srinivasan B, Singh N, Gopal L (2019) Late onset Descemet’s membrane detachment: 15 years after limbal lensectomy with vitrectomy for ROP. Indian J Ophthalmol 67(6):965–966. https://doi.org/10.4103/ijo.IJO_725_18
HerminaStrungaru M, Ali A, Rootman D, Mireskandari K (2017) Endothelial keratoplasty for posterior polymorphous corneal dystrophy in a 4-month-old infant. Am J Ophthalmol Case Rep 7:23–26. https://doi.org/10.1016/j.ajoc.2017.05.001
Low JR, Anshu A, Tan ACS, Htoon HM, Tan DTH (2014) The outcomes of primary pediatric keratoplasty in Singapore. Am J Ophthalmol 158(3):496–502. https://doi.org/10.1016/j.ajo.2014.05.020
Kothari M, Rao K, Moolani S (2014) Recurrent progressive anterior segment fibrosis syndrome following a Descemet-strip** endothelial keratoplasty in an infant with congenital aniridia. Indian J Ophthalmol 62(2):246–248. https://doi.org/10.4103/0301-4738.128635
Gonnermann J, Klamann MKJ, Maier AKB, Bertelmann E, Schroeter J, Von Au K et al (2014) Descemet membrane endothelial keratoplasty in a child with corneal endothelial dysfunction in Kearns-Sayre syndrome. Cornea 33(11):1232–1234. https://doi.org/10.1097/ICO.0000000000000252
Sella R, Rootman D, Bahar I (2013) Descemet’s strip** automated endothelial keratoplasty for posterior polymorphous corneal dystrophy in an 8-month-old boy. J AAPOS 17(1):94–96. https://doi.org/10.1016/j.jaapos.2012.09.009
Sati A, Ramappa M, Chaurasia S (2013) Cataract following endothelial keratoplasty (EK) in a child. Med J Armed Forces India 69(4):398–399. https://doi.org/10.1016/j.mjafi.2012.08.027
Lenhart PD, Evans CT, Beck AD, Lee WB (2013) Visual outcome after Descemet’s strip** automated endothelial keratoplasty in an 8-month-old with congenital hereditary endothelial dystrophy. J AAPOS 17(6):637–639. https://doi.org/10.1016/j.jaapos.2013.08.005
Kymionis GD, Kontadakis GA, Plaka A, Kankariya VP (2013) First bilateral pediatric Descemet strip** automated endothelial keratoplasty. J AAPOS 17(3):337–338. https://doi.org/10.1016/j.jaapos.2013.01.008
Hong Y, Peng RM, Wang M, Qu HQ, Hong J (2013) Suture pull-through insertion techniques for Descemet strip** automated endothelial keratoplasty in Chinese phakic eyes: outcomes and complications. PloS one 8(4):e61929. https://doi.org/10.1371/journal.pone.0061929 (Print 2013)
Beltz J, Madi S, Santorum P, Scorcia V, Busin M (2013) Descemet strip** automated endothelial keratoplasty for endothelial decompensation in buphthalmos. Am J Ophthalmol 156(3):608–15.e1. https://doi.org/10.1016/j.ajo.2013.04.022
Ashar JN, Ramappa M, Vaddavalli PK (2013) Paired-eye comparison of Descemet’s strip** endothelial keratoplasty and penetrating keratoplasty in children with congenital hereditary endothelial dystrophy. Br J Ophthalmol 97(10):1247–1249. https://doi.org/10.1136/bjophthalmol-2012-302602
Ashar JN, Ramappa M, Chaurasia S (2013) Endothelial keratoplasty without Descemet’s strip** in congenital hereditary endothelial dystrophy. J AAPOS 17(1):22–24. https://doi.org/10.1016/j.jaapos.2012.09.013
Ramappa M, Ashar J, Vaddavalli PK, Chaurasia S, Murthy SI (2012) Endothelial keratoplasty in children: surgical challenges and early outcomes. Br J Ophthalmol 96(8):1148–1149. https://doi.org/10.1136/bjophthalmol-2011-300941
Madi S, Santorum P, Busin M (2012) Descemet strip** automated endothelial keratoplasty in pediatric age group. Saudi J Ophthalmol 26(3):309–313. https://doi.org/10.1016/j.sjopt.2012.04.006
Kymionis GD, Kankariya VP, Diakonis VF, Karavitaki AE, Siganos CS, Pallikaris IG (2012) Descemet strip** automated endothelial keratoplasty in a child after failed penetrating keratoplasty. J AAPOS 16(1):95–96. https://doi.org/10.1016/j.jaapos.2011.09.009
Hashemi H, Ghaffari R, Mohebi M (2012) Posterior lamellar keratoplasty (DSAEK) in Peters anomaly. Cornea 31(10):1201–1205. https://doi.org/10.1097/ICO.0b013e31825697a4
Goshe JM, Li JY, Terry MA (2012) Successful Descemet’s strip** automated endothelial keratoplasty for congenital hereditary endothelial dystrophy in a pediatric patient. Int Ophthalmol 32(1):61–66. https://doi.org/10.1007/s10792-011-9511-3
Chaurasia S, Ramappa M, Sangwan VS (2012) Clinical outcomes of non-Descemet strip** automated endothelial keratoplasty. Int Ophthalmol 32(6):571–575. https://doi.org/10.1007/s10792-012-9615-4
Ashar JN, MadhaviLatha K, Vaddavalli PK (2012) Descemet’s strip** endothelial keratoplasty (DSEK) for children with congenital hereditary endothelial dystrophy: surgical challenges and 1-year outcomes. Graefes Arch Clin Exp Ophthalmol 250(9):1341–5. https://doi.org/10.1007/s00417-012-2014-8
Anwar HM, El Danasoury AM, Hashem AN (2012) Descemet’s strip** automated endothelial keratoplasty for congenital hereditary endothelial dystrophy. Clin Ophthalmol 6(1):159–163. https://doi.org/10.2147/OPTH.S28405
Busin M, Beltz J, Scorcia V (2011) Descemet-strip** automated endothelial keratoplasty for congenital hereditary endothelial dystrophy. Arch Ophthalmol (Chicago, Ill : 1960) 129(9):1140–6. https://doi.org/10.1001/archophthalmol.2011.114
Bellucci R, Chierego C, Bellucci C (2011) Endothelial keratoplasty in a newborn baby with CHED. Cornea 30(12):1488–1490. https://doi.org/10.1097/ICO.0b013e318221c2f3
Pineda IR, Jain V, Shome D, Hunter DC, Natarajan S (2010) Descemet’s strip** endothelial keratoplasty: is it an option for congenital hereditary endothelial dystrophy? Int Ophthalmol 30(3):307–310. https://doi.org/10.1007/s10792-009-9315-x
Belliveau MJ, Rocha G, Manchur A, Brownstein S (2010) Bilateral Descemet’s strip** with endothelial keratoplasty for posterior polymorphous corneal dystrophy in a young phakic patient. Can J Ophthalmol 45(2):180–181. https://doi.org/10.1139/i09-199
Ponchel C, Malecaze F, Arne JL, Fournie P (2009) Descemet strip** automated endothelial keratoplasty in a child with Descemet membrane breaks after forceps delivery. Cornea 28(3):338–41. https://doi.org/10.1097/ICO.0b013e3181861c40
Jun B, Kuo AN, Afshari NA, Carlson AN, Kim T (2009) Refractive change after Descemet strip** automated endothelial keratoplasty surgery and its correlation with graft thickness and diameter. Cornea 28(1):19–23. https://doi.org/10.1097/ICO.0b013e318182a4c1
Jeng BH, Marcotty A, Traboulsi EI (2008) Descemet strip** automated endothelial keratoplasty in a 2-year-old child. J AAPOS 12(3):317–318. https://doi.org/10.1016/j.jaapos.2008.04.007
Fernandez MM, Buckley EG, Afshari NA (2008) Descemet strip** automated endothelial keratoplasty in a child. J AAPOS 12(3):314–316. https://doi.org/10.1016/j.jaapos.2008.03.002
Price MO, Price FW Jr, Trespalacios R (2007) Endothelial keratoplasty technique for aniridic aphakic eyes. J Cataract Refract Surg 33(3):376–379. https://doi.org/10.1016/j.jcrs.2006.10.052
Liu S, Veldman P (2017) Evidence-based endothelial rehabilitation. Semin Ophthalmol 32(1):96–103. https://doi.org/10.1080/08820538.2016.1228409
Holz HA, Meyer JJ, Espandar L, Tabin GC, Mifflin MD, Moshirfar M (2008) Corneal profile analysis after Descemet strip** endothelial keratoplasty and its relationship to postoperative hyperopic shift. J Cataract Refract Surg 34(2):211–4. https://doi.org/10.1016/j.jcrs.2007.09.030
Koenig SB, Covert DJ, Dupps WJ Jr, Meisler DM (2007) Visual acuity, refractive error, and endothelial cell density six months after Descemet strip** and automated endothelial keratoplasty (DSAEK). Cornea 26(6):670–4. https://doi.org/10.1097/ICO.0b013e3180544902
Clemmensen K, Ivarsen A, Hjortdal J (2015) Changes in corneal power after Descemet strip** automated endothelial keratoplasty. J Refract Surg 31(12):807–12. https://doi.org/10.3928/1081597X-20151111-04
Prasher P, Muftuoglu O, Bowman RW, Cavanagh HD, McCulley JP, Mootha VV (2010) Corneal power measurement with a rotating Scheimpflug imaging system after Descemet-strip** automated endothelial keratoplasty. J Cataract Refract Surg 36(8):1358–64. https://doi.org/10.1016/j.jcrs.2010.01.032
Author information
Authors and Affiliations
Corresponding authors
Ethics declarations
Financial Support
None.
Conflict of interest
The authors declare no competing interests.
Additional information
Publisher's note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Supplementary Information
Below is the link to the electronic supplementary material.
Rights and permissions
About this article
Cite this article
Mohebbi, M., Mehrpour, M., Sanij, A.D. et al. Pediatric endothelial keratoplasty: a systematic review and individual participant data meta-analysis. Graefes Arch Clin Exp Ophthalmol 260, 1069–1082 (2022). https://doi.org/10.1007/s00417-021-05459-8
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00417-021-05459-8