Use of Decellularized Descemet Membrane Anterior Keratoplasty to Facilitate Epithelialization of Pediatric Penetrating Keratoplasty for Total Sclerocornea.

Purpose: To report the first known use of combined decellularized Descemet membrane anterior keratoplasty with penetrating keratoplasty (PKP) in a pediatric patient.

Methods: A 2-month-old boy with bilateral sclerocornea underwent bilateral sequential PKP. In the left eye, PKP performed at 2 months of age was complicated by a persistent epithelial defect postoperatively with a 1 month delay in epithelialization. As a result, the patient underwent PKP with a combined decellularized Descemet membrane corneal allograft implantation in the right eye at 3 months of age to enhance early postoperative healing. This was performed by creating a central 3-mm superficial keratectomy before placing Descemet membrane allograft onto the full-thickness graft.

Results: Compared to the 1-month delay in epithelialization after PKP in the left eye, the right eye, which underwent combined PKP and decellularized Descemet membrane corneal allograft, was fully epithelialized by the first postoperative week. The grafts remain clear and intact at 12 months of age. The patient exhibited significant improvement in visual behavior.

Conclusions: This case highlights the successful use of decellularized Descemet membrane anterior keratoplasty in preventing a persistent epithelial defect in the early postoperative period for a pediatric patient with sclerocornea. This may be a viable option for similar pediatric cases with delayed epithelial healing while promoting graft survival and minimizing the need for additional surgical interventions.