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Update on epikeratophakia in children
Insights
Epikeratophakia offers a safer alternative to IOL implantation for children with unilateral aphakia and contact lens intolerance. This procedure can also aid in rehabilitating corneas damaged by trauma.
Area of Science:
- Ophthalmology
- Pediatric Surgery
- Corneal Surgery
Background:
- Unilateral aphakia in children often presents challenges with contact lens compliance.
- Intraocular lens (IOL) implantation carries higher risks compared to alternative procedures.
- Traumatic eye injuries can result in aphakia and corneal damage, necessitating specialized treatment.
Purpose of the Study:
- To evaluate epikeratophakia as a viable treatment for pediatric unilateral aphakia.
- To assess the safety and efficacy of epikeratophakia in specific pediatric ocular conditions.
- To compare epikeratophakia with other treatment modalities like IOL implantation and contact lenses.
Main Methods:
- Review of epikeratophakia procedures in pediatric patients with unilateral aphakia.
- Analysis of outcomes in cases of traumatic aphakia and corneal lacerations.
- Consideration of combined procedures with cataract extraction.
- Evaluation of contraindications and cautious application in specific patient groups.
Main Results:
- Epikeratophakia is a safer alternative to IOL implantation for pediatric aphakia.
- The procedure effectively strengthens and smooths the cornea in traumatic cases, facilitating quicker rehabilitation.
- It can be combined with cataract extraction in compliant patients.
- Caution is advised in neonates due to eye growth; extended-wear contact lenses are preferred initially.
Conclusions:
- Epikeratophakia is a valuable, safer option for children with unilateral aphakia and contact lens intolerance.
- It offers significant benefits for traumatic aphakia and corneal injuries.
- Careful patient selection is crucial, avoiding cases with severe ocular surface disease or systemic health issues.
Abstract:
Epikeratophakia continues to be an extremely attractive option for younger children with unilateral aphakia who are noncompliant users of contact lenses but who are young enough to benefit from amblyopia therapy. The epikeratophakia procedure is much safer than IOL implantation. The epikeratophakia tissue lens is especially useful for children with traumatic aphakia and corneal lacerations because the lens can strengthen and smooth the cornea as well as correct the aphakia. This allows much quicker rehabilitation than could be accomplished with contact lenses. The epikeratophakia procedure may be combined with a cataract extraction and should be in those children with acquired cataracts who demonstrate contact lens noncompliance in an office trial of contact lens insertion before operation. Epikeratophakia should be used with caution in neonates and young infants because of the rapid growth of the eye. Extended-wear contact lenses are a safer option for these children, and epikeratophakia can be performed as a secondary procedure if and when problems with contact lens compliance arise. Surface ocular problems such as uncontrolled dry eyes or severe blepharitis will continue to be incompatible with the survival of epikeratophakia tissue lenses. Children who are treated with high doses of radiation for orbital tumors such as rhabdomyosarcomas invariably develop radiation cataracts, which can occur before the onset of radiation keratitis. These children do not do well with epikeratophakia tissue lenses. Likewise, children with severe metabolic disturbances who are not healthy or gaining weight have a diminished chance of graft healing, as do children with poor vision in whom oculodigital autostimulation produces persistent epithelial defects, which prevent survival of the tissue lens.(ABSTRACT TRUNCATED AT 250 WORDS)