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Deep anterior lamellar keratoplasty in children
Jatin N Ashar1, Shivani Pahuja, Muralidhar Ramappa
1L.V. Prasad Eye Institute, Kallam Anji Reddy Campus, Hyderabad, India.
Insights
Deep anterior lamellar keratoplasty (DALK) is a viable surgical option for children with corneal diseases, offering reduced rejection risk. However, potential complications like suture-related infections and graft dehiscence require careful monitoring.
Area of Science:
- Ophthalmology
- Corneal Surgery
- Pediatric Ophthalmology
Background:
- Deep anterior lamellar keratoplasty (DALK) is an alternative to penetrating keratoplasty for corneal stromal diseases.
- Pediatric corneal transplantation presents unique challenges and outcomes compared to adults.
Purpose of the Study:
- To evaluate the visual outcomes and complication rates of DALK in pediatric patients.
- To assess the feasibility of DALK in children with various stromal corneal pathologies.
Main Methods:
- A retrospective interventional case series was conducted.
- Twenty-six eyes of 26 children (<16 years) underwent DALK between January 2003 and January 2011.
- Visual outcomes and complications were the primary outcome measures, with a minimum follow-up of 6 months for visual assessment.
Main Results:
- DALK was performed for conditions including keratoconus, microbial keratitis, corneal scars, and chemical injuries.
- Final visual acuity ranged widely, from counting fingers to 20/20.
- Complications included suture-related graft infiltrate (3 eyes), graft dehiscence (3 eyes), and Descemet membrane detachment (2 eyes).
Conclusions:
- DALK is a feasible surgical option for children with stromal corneal pathology.
- The procedure offers a lower risk of graft rejection compared to traditional corneal transplants.
- Persistent risks of complications such as suture-related infections and graft dehiscence necessitate vigilant postoperative care.
Purpose:
To evaluate the outcomes of deep anterior lamellar keratoplasty (DALK) in children.
Design:
Retrospective interventional case series.
Methods:
setting: Institutional, L.V. Prasad Eye Institute, a tertiary care center in south India. study population and intervention: All children less than 16 years of age undergoing DALK from January 2003 to January 2011. main outcome measure: Visual outcome and complications.
Results:
Twenty-six eyes of 26 children (13 male and 13 female) with a mean age of 7.82 ± 4.64 years underwent DALK for keratoconus (8), microbial keratitis (6), corneal scar (6), corneal keloid (3), chemical injury with limbal stem cell deficiency (2), and dermoid (1). Big bubble was achieved in 5 eyes, while manual dissection was done in 21. Follow-up ranged from 1 week to 7.3 years. Seventeen patients with a minimal follow-up of 6 months were evaluated for visual outcomes. Final vision varied from counting fingers to 20/20 (mean sphere 2.32 diopters, mean cylinder -2.5 diopters). Complications encountered were suture-related graft infiltrate (3), graft dehiscence (3), and Descemet membrane detachment (2).
Conclusions:
DALK is a feasible option in children with stromal corneal pathology. It offers advantages in the form of lower risk of graft rejection. However, the risk of complications such as suture-related infections and graft dehiscence persists even in these cases.
