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Published on: September 17, 2014
Penetrating keratoplasty in infancy and early childhood
1Department of Ophthalmology, State University of New York, School of Medicine & Biomedical Sciences, Buffalo, New York, USA. jreidy@buffalo.edu
Insights
Penetrating keratoplasty for congenital corneal opacity in children requires early intervention to prevent amblyopia. Specialized surgical techniques and a multispecialty team approach are crucial for successful visual outcomes in pediatric corneal transplants.
Area of Science:
- Ophthalmology
- Pediatric Surgery
- Corneal Transplantation
Background:
- Penetrating keratoplasty (PKP) in infants and young children is uncommon.
- The primary indication for pediatric PKP is visually significant congenital corneal opacity.
- Early surgical intervention is vital to prevent irreversible amblyopia.
Purpose of the Study:
- To outline the specific considerations and techniques for performing penetrating keratoplasty in pediatric patients.
- To identify factors influencing the success of corneal transplantation in infants and young children.
Main Methods:
- Adaptation of surgical techniques from adult PKP to account for reduced ocular rigidity in pediatric eyes.
- Emphasis on a multispecialty team approach for optimal patient care.
- Identification and analysis of prognostic indicators for pediatric corneal grafts.
Main Results:
- Key poor prognostic indicators identified: bilateral disease, infantile glaucoma, combined lensectomy/vitrectomy, prior graft failure, extensive goniosynechiae, and corneal vascularization.
- Successful outcomes depend on prompt postoperative optical rehabilitation and occlusion therapy.
Conclusions:
- Pediatric penetrating keratoplasty presents unique surgical challenges compared to adults.
- A comprehensive approach involving specialized surgical techniques, a multidisciplinary team, and diligent postoperative care is essential for maximizing visual recovery in children undergoing corneal transplantation.
Abstract:
Penetrating keratoplasty in infants and young children is performed on an infrequent basis. The most common indication is visually significant congenital corneal opacity. Surgery must be performed early to avoid amblyopia. Surgical techniques differ from those used in adult penetrating keratoplasty because of the reduced ocular rigidity encountered in infants and young children. Use of a multispecialty team approach is important to improve visual outcome. Poor prognostic indicators include bilateral disease, concomitant infantile glaucoma, lensectomy and vitrectomy at the time of surgery, previous graft failure, extensive goniosynechiae, and extensive corneal vascularization. Prompt postoperative optical rehabilitation, combined with occlusion therapy when appropriate, is an important determinant of success.
