This retrospective case series reports the long-term outcomes of Descemet stripping endothelial keratoplasty (DSEK) with suture assisted donor lenticular assisted donor lenticule insertion in paediatric patients with congenital hereditary endothelial dystrophy (CHED). Thirty eyes of 16 patients were reviewed and long-term clinical outcomes and complications were compared and reported. The patients were divided into a child group and an infant group. There was no statistical difference between the corneal transparency scores between the two groups at day seven postoperatively. Best corrected visual acuity (BCVA) was better in the infant group than the child group (logMAR 0.32 vs. logMAR 0.54). Thirty-three percent of cases in the child group and 86% of cases in the infant group had a BCVA equal to or better than logMAR 0.4. Endothelial cell density was only assessed in the child group and the average cell loss was 31.21% 9.17%. There were no signs of endothelial rejection or graft dysfunction in any of the eyes in either group until the final visit. Graft detachment occurred in three eyes of the child group and none of the infant group. Two of these had an attempt to be repositioned but both failed and all resulted in a penetrating keratoplasty (PK) being performed. This study has suggested that DSEK could be a good alternative to conventional PK, however, additional longer term and larger population studies are needed.
Descemet stripping endothelial keratoplasty: surgical management of congenital hereditary endothelial dystrophy
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