Pre-Descemet Endothelial Keratoplasty With Infant Donor Corneas: A Prospective Analysis

Purpose: To evaluate the outcomes and feasibility of the use of infant donor tissue (<1 year) in pre-Descemet endothelial keratoplasty (PDEK). Methods: Three eyes of 3 patients with pseudophakic bullous keratopathy underwent the procedure in this single-center, prospective interventional series. Diseased Descemet membrane of the recipient cornea was replaced with the pre-Descemet layer-Descemet membrane-endothelium complex stripped from the infant donor cornea (9-12 months old) with the creation of a type 1 bubble. The main outcome measures were best-corrected visual acuity, endothelial cell density, endothelial cell loss, and ease and predictability of the donor lenticule preparation. Results: In the postoperative period, there was improvement in the visual acuity in all the patients. The mean donor endothelial cell density was 3073 68 cells per square millimeter, and the mean postoperative specular count at 6 months was 2230 +/- 43 cells per square millimeter. The mean percentage loss of endothelial cells at 6 months was 27 +/- 2%. The mean coefficient of variation was 36 +/- 5.2%. The mean central corneal thickness measured at a 6-month postoperative period was 515 +/- 7 mu m. No incidence of tissue loss during graft preparation, graft dislocation, or graft failure was reported. The mean graft thickness as measured with optical coherence tomography on the first postoperative day was 35 +/- 3 mu m. Conclusions: PDEK using an infant cornea provided an effective means of restoring optical clarity with good visual outcomes. The infant cornea can be a reliable source of donor tissue for the PDEK procedure, and no difficulties were noted in the donor lenticule preparation, insertion of the donor graft, or air bubble management.