Lamellar keratoplasty in children

Lamellar keratoplasty procedures have gained momentum in the field of corneal transplantation because of their inherent advantages over full-thickness penetrating keratoplasty. While penetrating keratoplasty is an open sky procedure fraught with sight-threatening intraoperative and postoperative complications, lamellar keratoplasties are relatively closed-system procedures that involve selective removal and replacement of diseased corneal layers and are free from these complications. Anterior lamellar procedures involve partial or lamellar replacement of anterior stroma and reduce the risk of graft rejection, retain structural integrity, and require less stringent donor criteria. Posterior lamellar procedures involve removal of the affected endothelium in eyes with relatively unaffected stroma. These procedures are associated with improved safety profile, accelerated wound healing, structurally stronger globe, and minimal astigmatism, thereby producing faster visual rehabilitation and timely initiation of amblyopia therapy in children. Although the use of lamellar grafts is increasing in adults, their relatively slower adoption in pediatric population is attributable to the steep learning curve and lack of long-term follow-up data. We describe the challenges associated with these procedures and their outcomes in pediatric eyes.