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Keratoplasty for keratomalacia in preschool children
R B Vajpayee1, M Vanathi, R Tandon
1Rajendra Prasad Centre For Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India.
Insights
Surgical management of keratomalacia in children, a severe corneal melting condition, yielded poor visual outcomes. Corneal grafting success rates were low, highlighting the challenges in treating this pediatric eye disease.
Area of Science:
- Ophthalmology
- Pediatric Surgery
- Corneal Diseases
Background:
- Keratomalacia is a severe form of corneal ulceration often seen in malnourished children.
- It is frequently associated with systemic illnesses and lack of immunisation.
- Early diagnosis and intervention are crucial but often challenging.
Purpose of the Study:
- To evaluate the outcomes of surgical interventions for keratomalacia in pediatric patients.
- To analyze the factors influencing the success of corneal grafting in this condition.
Main Methods:
- A clinical case series was conducted on 29 children with keratomalacia admitted to an Indian center.
- Data collected included demographics, systemic associations, and results of medical and surgical treatments.
- Surgical interventions included emergency tectonic and optical penetrating keratoplasty.
Main Results:
- The study included children aged 2 months to 5 years, predominantly from lower socioeconomic backgrounds and unvaccinated.
- Common precipitating factors were measles, pneumonia, and acute diarrhea.
- Corneal grafting showed low graft clarity rates: 33.3% for tectonic and 57.14% for optical keratoplasty, with no cases achieving better than 6/60 visual acuity.
Conclusions:
- Corneal grafting surgery for keratomalacia in children is associated with unfavorable visual prognoses.
- The findings underscore the limitations of current surgical approaches and the need for improved preventative and therapeutic strategies.
Aim:
To study the results of surgical management of keratomalacia in children.
Methods:
A clinical case series of all children with keratomalacia, admitted to an Indian centre during the period from June 2000 to June 2001 is presented. The parameters evaluated were demographic data, systemic associations, and results of medical and surgical intervention.
Results:
29 children with keratomalacia ranging from 2 months to 5 years of age (mean 1.8 (SD 1.4) years) were included in the study. All children belonged to families of lower socioeconomic status. 27 patients (93.1%) had not been immunised at all. The systemic diseases precipitating the onset of keratomalacia included measles (41.37%), pneumonia (31.03%), and acute diarrhoea (37.93%). 36 eyes (66.7%) had total corneal melting and 11 (20.3%) eyes had paracentral corneal melting. In 15 eyes (27.8%) an emergency tectonic penetrating keratoplasty was performed of which only five grafts (33.3%) remained clear at a mean follow up of 7.3 (6.8) months (range 3-24 months). Seven eyes underwent optical penetrating keratoplasty, of which four grafts (57.14%) remained clear at a mean follow up of 6.4 (3.6) months (range 3-12 months). None of these could achieve a visual acuity better than 6/60.
Conclusions:
Corneal grafting surgery in keratomalacia is associated with poor visual outcome.