DSAEK may be effective in cases of congenital hereditary endothelial dystrophy

Arch Ophthalmol. 2011;129(9):1140-1146

Descemet stripping automated endothelial keratoplasty quickly restored corneal clarity and minimized complications in patients treated for congenital hereditary endothelial dystrophy, a study found.

Patients with congenital hereditary endothelial dystrophy have traditionally undergone penetrating keratoplasty, the study authors said.

"However, to date, no definite evidence of the appropriate timing for PK has been found, as the risk of amblyopia must be weighed against the increased risk of complications described when this type of surgery is performed in children," they said. "Our data suggest performing surgery at an earlier age, thus providing opportunity for improved visual development and potentially avoiding amblyopia."

The chart review included 15 eyes of eight patients with congenital hereditary endothelial dystrophy who underwent DSAEK. Mean patient age was 9 years (range: 6 months to 30 years).

All patients were phakic. Preoperative best corrected visual acuity exceeded 20/200 in three eyes and was 20/200 or less in six eyes.

Four cases of graft detachment required the re-bubbling technique to reattach the grafts. Average follow-up was 15.9 months.

Study results showed that all corneas were clear within 1 week after surgery. No cases of lenticular opacity were reported during follow-up.

Postoperative best corrected visual acuity was 20/40 or better in eight eyes. Average endothelial cell loss was 30% in seven eyes for which cell loss data were available.

Six eyes of three infants were able to fixate and follow 1 week after surgery on the second eye.