Update on pediatric corneal diseases and keratoplasty
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Published on: November 17, 2014
Murugesan Vanathi1, Nimmy Raj1, Rakhi Kusumesh2
1Cornea, Lens & Refractive Services, Dr. R P Centre for Ophthalmic Sciences - All India Institute Of Medical Sciences, New Delhi, India.
Insights
Pediatric keratoplasty outcomes depend on many factors, including surgical technique and patient compliance. Advances in lamellar keratoplasty offer improved graft survival rates for children with corneal disorders.
Area of Science:
- Ophthalmology
- Pediatric Surgery
- Corneal Diseases
Background:
- Pediatric corneal disorders present unique management challenges impacting visual development.
- Congenital corneal diseases are increasingly understood through genetic research.
- Corneal transplantation in children faces hurdles like graft failure and amblyopia.
Purpose of the Study:
- To review current challenges and advancements in pediatric keratoplasty.
- To discuss evolving surgical techniques for pediatric corneal conditions.
- To highlight factors influencing outcomes in pediatric corneal transplantation.
Main Methods:
- Review of current literature on pediatric keratoplasty.
- Analysis of factors affecting surgical outcomes in children.
- Discussion of lamellar keratoplasty techniques in pediatric cases.
Main Results:
- Lamellar keratoplasty techniques (anterior and posterior) are increasingly used in pediatric eyes.
- These techniques may reduce the risk of graft rejection compared to traditional methods.
- Preoperative indications, surgical timing, and postoperative care significantly influence outcomes.
Conclusions:
- Despite advancements, pediatric keratoplasty remains complex due to factors like amblyopia and graft issues.
- Careful patient selection, surgical technique, and management are crucial for successful outcomes.
- Lamellar keratoplasty shows promise for improving pediatric corneal transplantation results.
Abstract:
Managing pediatric corneal disorders is challenging as the prognosis of pediatric keratoplasty depends on several factors. Advancements in the genetic basis of congenital corneal diseases and investigations in congenital corneal conditions provide a better understanding of pediatric corneal conditions. Surgeons performing keratoplasty in children now have a choice of various techniques. Evolving surgical techniques of anterior lamellar and endothelial keratoplasties have expanded the management interventions in these pediatric corneal morbidity conditions; however, considerable concerns still exist in association with corneal transplantation in infants and children. Outcomes in pediatric keratoplasty depend upon the preoperative indications, the timing of surgical intervention, intraoperative and postoperative factors including the patient/care givers' compliance. Factors such as low scleral rigidity, higher rate of graft failure, need for frequent examinations under anesthesia, and difficulty in optimal visual acuity assessment still remain a considerable challenge in pediatric scenarios. In children, deprivation amblyopia as a result of the corneal opacification can adversely affect visual development, causing dense amblyopia. Outcomes to surgical interventions for management of corneal opacification in children are further compromised by the preexisting amblyopia apart from the concerns of refractive outcome of the graft. Graft rejection, graft infection, amblyopia, and glaucoma continue to be serious concerns. In recent years both anterior and posterior lamellar keratoplasty techniques are being increasingly performed in pediatric eyes, which offer advantages in the form of lower risk of graft rejection. The timing of surgery, careful case selection, cautious intraoperative approach, and optimal postoperative management can improve the anatomical and functional outcome in difficult cases.
