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Pediatric Keratoplasty: The Success of a Tailor-Made Surgical Management
Raffaele Nuzzi1, Alessandro Rossi1
1Institute of Ophthalmology, Department of Surgical Sciences, University of Turin, Turin, Italy.
Insights
Congenital corneal opacities in infants require individualized surgical planning. Pediatric penetrating keratoplasty (PKP) can achieve good visual outcomes with careful case-by-case evaluation and innovative techniques.
Area of Science:
- Ophthalmology
- Pediatric Surgery
Background:
- Congenital corneal opacities present a significant challenge in pediatric vision.
- Early surgical intervention is crucial for visual development in infants.
Observation:
- A 5-month-old girl with bilateral congenital corneal opacities and esotropia underwent penetrating keratoplasty (PKP).
- Lamellar keratoplasty was deemed technically unfeasible due to full-thickness opacity.
- An innovative interrupted suture technique using alternating 11-0/10-0 nylon threads was employed.
Findings:
- The patient achieved a functional visual acuity of 4-5/10 six months post-PKP.
- Successful recovery of visual fixation was observed.
Implications:
- Pediatric PKP necessitates a tailored, case-by-case approach from preoperative assessment to postoperative care.
- Optimizing stable visual acuity in pediatric corneal opacity requires meticulous surgical planning and execution.
Abstract:
A Romanian 5-month-old girl was referred to our hospital after being diagnosed with congenital corneal opacities. She was sent in order to undergo penetrating keratoplasty (PKP) surgery on her left eye. The patient presented a natural tendency to esotropia. We took into account two different surgical techniques: PKP and lamellar keratoplasty. The latter was technically impossible to carry out because of the full-thickness corneal opacity. We conducted several tests to accurately obtain the patient's preoperative parameters and specifically decide the details of the surgical technique to be applied. For each step of the surgical procedure we carefully compared the individual results in the literature in order to ensure a stable and lasting result. In addition to this, we used an innovative suture technique: nylon thread, interrupted suture, alternating 11-0/10-0 threads. Six months after the operation, the functional result obtained was 4-5/10, with recovery of the fixation. Pediatric PKP, therefore, cannot follow a surgical standard, but requires careful case-by-case evaluation from the pre- to the postoperative phase, with the aim of maximizing stable visual acuity.
