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PUBLIC RELEASE DATE:
15-Jul-2008

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Contact: Jayne Dawkins
ja.dawkins@elsevier.com
215-239-3674
Elsevier
@elseviernews

Corneal transplant technique shows promise in children

DSAEK may offer new alternative to difficult cornea surgery in children, JAAPOS reports

Philadelphia, PA, July 15, 2008 - For infants and children with blinding diseases of the cornea, a sophisticated new corneal transplantation technique offers the hope of improving vision while overcoming the technical difficulty and low success rate of traditional penetrating keratoplasty (PK) in children, according to reports in the current issue of the Journal of AAPOS (American Association for Pediatric Ophthalmology and Strabismus).

The issue includes two case reports on the successful use of "Descemet stripping automated endothelial keratoplasty" (DSAEK) in children with corneal disease. If the promising results are borne out by further research, DSAEK could provide an alternative to traditional corneal transplantation--a notoriously difficult procedure in children, failing more often than it succeeds.

Dr. Bennie H. Jeng and colleagues of The Cleveland Clinic Cole Eye Institute performed DSAEK in a 21-month-old boy, while Dr. Mark M. Fernandez and colleagues of Duke University Eye Center report the results of DSAEK in a 9-year-old boy. Both children had irreversible damage to the corneal endothelium--a specialized, single-cell layer at the rear (posterior) of the cornea--after complications of cataract surgery.

In DSAEK, the diseased endothelium is removed and replaced by a "button" of healthy endothelium from a cornea donor. After careful handling and meticulous placement, the button is held in place for the first 24 hours by nothing more than a bubble of air--during this time, the patient must lie flat to keep the air bubble and transplant in place.

In adults, DSAEK is currently "in vogue" as an alternative to traditional penetrating keratoplasty, according to a commentary by Dr. Kathryn Colby of Massachusetts Eye and Ear Infirmary, Harvard Medical School. DSAEK offers several advantages over PK. One key advantage is much more rapid recovery of vision--within 6 to 12 weeks after DSAEK, compared to 6 to 12 months with traditional PK surgery.

Shorter recovery time is especially important in young children with developing vision, who are at risk of further, potentially severe vision loss (amblyopia). Both children in the case reports had good results, showing improved vision within a few months after DSAEK.

Because is less invasive, DSAEK also has a lower risk of certain complications compared to PK. Postoperative management is simplified because no sutures are placed in the cornea.

Many questions remain regarding the use of DSAEK in children. Since most children who need corneal transplants have other abnormalities as well, DSAEK would be an option in only about 20 percent of cases. The need to have the patient lie flat for 24 hours after surgery poses challenges in young children, and concerns about potential complications and long-term results have to be addressed. Other treatment options are emerging as well, including the use of an artificial cornea or "keratoprosthesis."

Meanwhile, DSAEK offers an exciting new treatment possibility at least for some children with corneal disease. "We now have an expanded repertoire of better surgical options for children needing PK," Dr. Colby concludes. "The future is bright for those who undertake these challenging, but potentially life-changing, surgeries."

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Notes to Editors:

Full text of the article mentioned above is available upon request. Contact Jayne M. Dawkins at (215) 239-3674 or ja.dawkins@elsevier.com to obtain a copy or to schedule an interview. The article appears in Journal of AAPOS, Volume 12, #3, 2008, published by Elsevier.

About Journal of AAPOS

Journal of AAPOS presents expert information on children's eye diseases and on strabismus as it impacts all age groups. Major articles by leading experts in the field cover clinical and investigative studies, treatments, case reports, surgical techniques, descriptions of instrumentation, current concept reviews, and new diagnostic techniques. The Journal is the official publication of the American Association for Pediatric Ophthalmology and Strabismus.

About Elsevier

Elsevier is a world-leading publisher of scientific, technical and medical information products and services. Working in partnership with the global science and health communities, Elsevier's 7,000 employees in over 70 offices worldwide publish more than 2,000 journals and 1,900 new books per year, in addition to offering a suite of innovative electronic products, such as ScienceDirect (http://www.sciencedirect.com/), MD Consult (http://www.mdconsult.com/), Scopus (http://www.info.scopus.com/), bibliographic databases, and online reference works.

Elsevier (http://www.elsevier.com/) is a global business headquartered in Amsterdam, The Netherlands and has offices worldwide. Elsevier is part of Reed Elsevier Group plc (http://www.reedelsevier.com/), a world-leading publisher and information provider. Operating in the science and medical, legal, education and business-to-business sectors, Reed Elsevier provides high-quality and flexible information solutions to users, with increasing emphasis on the Internet as a means of delivery. Reed Elsevier's ticker symbols are REN (Euronext Amsterdam), REL (London Stock Exchange), RUK and ENL (New York Stock Exchange).



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