Challenges in pediatric endothelial keratoplasty

• Main Authors: Vikas Mittal, Ruchi Mittal
• Format: Article
• Language: English
• Published: Wolters Kluwer Medknow Publications 2014-01-01
• Series: Indian Journal of Ophthalmology
• Subjects: Blindness; cataract; eye lens; risk factors; treatment of cataract; Low vision care; multiple disabilities and visual impairment; reading performance; Accommodation; presbyopia; supraciliary segment implants; Amblyopia; citicoline; patching; Corneal endothelium; human corneal endothelial precursor cells; in vitro expansion; sphere forming assay; thermo-reversible gelation polymer; transportation; Endophthalmitis; explantation; fungal; intraocular lens; postoperative; recurrent; Colour perception; learning disabilities; school children; stereo acuity; testability; visual acuity; Contracted socket; dermis fat graft; porous orbital implant; reconstruction; Glucose; in vitro anticataract; lens; Moringa oliefera; ′BARC I-125 Ocu-Prosta seeds′; choroidal melanoma; ciliary body melanoma; Episcleral plaque brachytherapy; retinal angioma; retinoblastoma; vasoproliferative tumor; Congenital glaucoma; gonioscopy; Retcam; Acoustic features; A-scan; B-scan; choroidal mass; ultrasound biomicroscopy; Cataract surgery; education; informed consent; multimedia; rural health; Lagophthalmos; silicone sling; temporalis muscle; Contrast sensitivity function; disability; function peak; multiple sclerosis; spatial frequency; Congenital cataract; developmental cataract; outcome; vision function; Bacterial; extracellular enzymes; keratitis; toxins; Exotropic Duane retraction syndrome; periosteal fixation; strabismus surgery; vertical rectus transposition; Descemet′s stripping endothelial keratoplasty; complications; donor dislocation; endothelial cell loss; graft failure; management; Glaucoma; glaucoma experimental; parapapillary atrophy; Juvenile open angle glaucoma; juvenile glaucoma; primary trabeculectomy; trabeculectomy in young; Collagen cross linking; keratoconus; topography guided custom ablation treatment; topography guided photoablation; Azithromycin; chloramphenicol; fluoroquinolone; non-chlamydia conjunctival bacteria; Ethiopia; near vision; prevalence of blindness; visual outcome; Congenital aniridia; descemet stripping endothelial keratoplasty; progressive anterior segment fibrosis syndrome; Early removal; high doses of steroids; mimics microbial keratitis; stingers; Childhood corneal opacity; congenital hereditary endothelial dystrophy; corneal edema; endothelial keratoplasty; pediatric keratoplasty
• Online Access: http://www.ijo.in/article.asp?issn=0301-4738;year=2014;volume=62;issue=2;spage=251;epage=254;aulast=Mittal
• ISSN: 0301-4738; 1998-3689

We performed endothelial keratoplasty (EK) in three eyes of two siblings (2.5 years, male and 3.5 years, female) with congenital hereditary endothelial dystrophy (CHED) and report the intraoperative and postoperative difficulties. Repeated iris prolapse, apprehension of crystalline lens touch due to positive vitreous pressure, and need for frequent air injections to attach the graft were intraoperative challenges in all three eyes. These were addressed by use of Sheet′s glide instead of Busin′s glide during graft insertion and suturing of main and side ports before air injection. One eye had graft dislocation on second postoperative day due to eye rubbing by the child. Graft was repositioned with air and a venting incision was created. Postoperative examination required repeated general anesthesia. Corneal edema resolved completely in all three eyes. Present case series highlights the possible intraoperative and postoperative challenges and their solutions in pediatric EK for CHED.