From the Department of Cornea and Refractive Surgery, Sankara Nethralaya, Medical Research Foundation, Chennai, Tamil Nadu, India..
From the Department of Cornea and Refractive Surgery, Sankara Nethralaya, Medical Research Foundation, Chennai, Tamil Nadu, India.
Am J Ophthalmol. 2021 Jul;227:12-17. doi: 10.1016/j.ajo.2021.02.011. Epub 2021 Feb 12.
To report the technique and outcome of Descemet membrane endothelial keratoplasty (DMEK) in pediatric patients older than 6 years of age.
Institutional interventional retrospective case series.
This study included 5 eyes of patients less than 15 years of age with endothelial dysfunction who underwent DMEK. Three eyes had Descemet stripping done of the same size as the donor graft. Two eyes underwent non-Descemet stripping endothelial keratoplasty. Attachment of DMEK scroll and improvement in corneal clarity, vision, pachymetry, and intraoperative or postoperative complication was noted. We defined primary graft failure as nonclearing corneal edema despite a well-attached lenticule on anterior segment optical coherence tomography.
A total of 5 eyes of 5 children (all male) with a mean (± standard deviation) age of 9.2 ± 3.42 years underwent DMEK. The mean preoperative visual acuity of 1.93 ± 0.25 logMAR units improved postoperatively to 0.98 ± 0.29 (95% confidence interval, P = .03). Anatomic success (well-attached scroll with a more transparent cornea with a decrease in pachymetry) was seen in 4 of 5 eyes (80%). One eye had a primary donor failure. Two out of the 5 eyes (40%) required rebubbling. The mean pachymetry in eyes with successful procedure reduced from 1094.5 ± 101.5 µm to 619.25 ± 150.3 µm (P = .03).
Although DMEK in pediatric eyes is challenging, the early results are encouraging, and it is a viable option in pediatric patients with endothelial failure.
报告大于 6 岁儿童的 Descemet 膜内皮角膜移植术（DMEK）的技术和结果。
机构介入回顾性病例系列。
本研究纳入了 5 例因内皮功能障碍而接受 DMEK 治疗的年龄小于 15 岁的患者的 5 只眼。其中 3 只眼行与供体移植物大小相同的 Descemet 膜撕除术，2 只眼行非 Descemet 膜撕除性内皮角膜移植术。观察 DMEK 卷的附着以及角膜清晰度、视力、角膜厚度和术中或术后并发症的改善情况。我们将原发性移植物失功定义为尽管前节光学相干断层扫描显示移植片附着良好，但角膜水肿仍未消退。
5 例（均为男性）5 只眼的平均（±标准差）年龄为 9.2 ± 3.42 岁，行 DMEK 治疗。术前平均视力为 1.93 ± 0.25 logMAR 单位，术后提高至 0.98 ± 0.29（95%置信区间，P=0.03）。4 只眼（80%）的解剖学成功（移植片附着良好，角膜更透明，角膜厚度降低）。1 只眼发生原发性供体失败。5 只眼中有 2 只（40%）需要重新注气。成功手术眼的平均角膜厚度从 1094.5 ± 101.5 µm 降低至 619.25 ± 150.3 µm（P=0.03）。
虽然儿童眼的 DMEK 具有挑战性，但早期结果令人鼓舞，对于内皮功能衰竭的儿童患者来说，DMEK 是一种可行的选择。
