Penetrating Keratoplasty Versus Descemet Stripping Automated Endothelial Keratoplasty in Children With Congenital Hereditary Endothelial Dystrophy: Long-Term Results.

PURPOSE: The purpose of this study was to compare the outcomes of Descemet stripping automated endothelial keratoplasty (DSAEK) and penetrating keratoplasty (PKP) in patients with congenital hereditary endothelial dystrophy (CHED). METHODS: This was a retrospective, comparative study of all the patients with a histopathological diagnosis of CHED who underwent PKP or DSAEK between January 1, 1990, and December 31, 2016. All the cases were included except those patients who had clear grafts but did not complete 2 years of postoperative follow-up. The main outcome measure was graft clarity 2 years after surgery. RESULTS: There were 111 eyes of 63 patients. Seventy-six eyes underwent PKP, and 35 eyes underwent DSAEK. The median age at surgery was 6.8 years in the PKP group and 10.32 years in the DSAEK group. At 2 years postoperatively, clear grafts were noted in 66 of 76 (86.8%) eyes in the PKP group and 30 of 35 (85.7%) eyes in the DSAEK group. At the last follow-up, 80.3% of PKP grafts and 82.8% of DSAEK grafts were clear ( P =0.5). The type and timing of complications differed between the 2 groups. The PKP group had a statistically significant higher rate of graft rejection (19.5%) versus the DSAEK group (0%) ( P =0.01). DSAEK complications were mainly lenticule detachment that developed within one month postoperatively. There was no statistically significant difference in the visual outcomes at the last follow-up between the groups. CONCLUSION: Endothelial keratoplasty is a safe alternative to conventional PKP in CHED. The visual outcome and survival rates were comparable, but DSAEK had a lower rejection rate and fewer suture-related complications.

Endophthalmitis following keratoplasty: incidence, microbial profile, visual and structural outcomes.

PURPOSE: To identify the causative organisms of post-keratoplasty endophthalmitis and to report its visual and structural outcomes. METHODS: A chart review was performed of all patients diagnosed with endophthalmitis after keratoplasty at a tertiary hospital between January 1990 and January 2007. RESULTS: Endophthalmitis developed in 55 cases in the penetrating keratoplasty group and in no cases in the lamellar keratoplasty group. The majority of isolated microbes were gram-positive (86.3%). Only 1 eye retained a clear graft with 20/25 vision; other cases had ≤20/200 vision. Four of 13 eyes that underwent vitrectomy and 28 of 42 that did not undergo vitrectomy ended up with no light perception. One eye that underwent vitrectomy and 21 eyes that did not undergo vitrectomy were eviscerated. CONCLUSIONS: Post-keratoplasty endophthalmitis was associated with poor visual and structural outcome. Gram-positive organisms were the most common cause of infection. Early vitrectomy may reduce functional and structural damage associated with endophthalmitis.