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Published on: November 17, 2014
Pediatric corneal transplantation: techniques, challenges, and outcomes
Bharat Gurnani, Kirandeep Kaur1,2, Sameer Chaudhary3
1Cataract, Paediatric Ophthalmology and Strabismus, India.
Insights
Pediatric corneal transplants are complex, with risks like infection and graft failure. Advances in lamellar keratoplasty and keratoprostheses improve visual outcomes for children.
Area of Science:
- Ophthalmology
- Pediatric Surgery
- Corneal Science
Background:
- Pediatric corneal transplantation presents unique surgical and clinical challenges.
- Indications include therapeutic, tectonic, optical, and cosmetic reasons.
- High-risk factors for pediatric graft failure include young age, immune response, trauma, and compliance issues.
Purpose of the Study:
- To review the epidemiology, etiology, indications, and management of pediatric corneal transplants.
- To highlight recent advances and future directions in the field.
- To emphasize factors crucial for successful pediatric corneal transplant outcomes.
Main Methods:
- Review of current literature on pediatric corneal transplantation.
- Analysis of indications, risk factors, and surgical techniques.
- Discussion of evolving management protocols and emerging technologies.
Main Results:
- Penetrating keratoplasty is common, but lamellar keratoplasty is increasingly favored for faster visual recovery and fewer complications.
- Keratoprostheses show promise for cases with multiple graft failures.
- Successful outcomes depend on meticulous pre-operative evaluation, surgical expertise, and diligent post-operative care.
Conclusions:
- Pediatric corneal transplantation requires specialized management to mitigate risks like infection, rejection, and amblyopia.
- Advancements in surgical techniques, such as lamellar keratoplasty, and devices like keratoprostheses are improving visual rehabilitation.
- Continued research and improved understanding will enhance anatomical and functional results for children requiring corneal transplants.
Abstract:
Pediatric corneal transplant is a highly demanding and technically challenging procedure for the cornea surgeon in today's era. These cases pose unique challenges in clinical and surgical management. The indications of pediatric corneal transplant can be therapeutic, tectonic, optical, and cosmetic. Pediatric patients undergoing corneal transplants are at a high risk of graft infection, failure, rejection, dehiscence, and amblyopia due to young age, robust immune system, increased incidence of trauma, and compliance issues. The other factors contributing to graft failure can be allograft rejection, secondary glaucoma, corneal vascularization, multiple surgeries, vitreous prolapse, and lack of treatment compliance. A successful corneal transplant in children depends on meticulous preoperative evaluation, uneventful surgery, the expertise of a corneal surgeon, and regular and timely postoperative follow-up. Therapeutic and optical penetrating keratoplasty are the most commonly performed transplants in children. However, with the advancements in surgical technique and management protocol, the current focus has shifted toward lamellar keratoplasty. Lamellar keratoplasty offers early visual recovery and potentially fewer complications. Visual rehabilitation through corneal transplant in otherwise blind eyes can be a boon for the children. Recently, keratoprostheses have been promising in children with multiple graft failures. The current review gives insights into epidemiology, etiology, indications, clinical characteristics, investigations, management options, recent advances, and the future of pediatric corneal transplants. As surgical techniques continue to grow and comprehension of pediatric corneal transplants is improving, we can safeguard these eyes with the best possible anatomical and functional outcomes.
