Pediatric Keratoplasty

Kaevalin Lekhanont; Divya Srikumaran; Esen Karamursel Akpek

Disclosures

Expert Rev Ophthalmol. 2008;3(6):655-663. 

In This Article

Abstract and Introduction

Corneal transplantation in a pediatric patient population poses special challenges that are not encountered in adults. The surgical procedure is technically more complex because of the small size of the globe, reduced rigidity of the cornea and sclera, and positive vitreous pressure with frequent anterior displacement of the lens-iris diaphragm. Severe inflammatory reaction, secondary glaucoma and immunological graft rejection are also much more likely to occur after surgery. Postoperative visual rehabilitation and amblyopia therapy are crucial but complex in a pediatric patient population. The combination of a dedicated multispecialty transplant team and the education and cooperation of the patient's family are imperative for a successful outcome.

Introduction

Corneal blindness remains a leading cause of childhood visual impairment, particularly in developing countries.[1,2,3,4,5,6,7] Providing a clear visual axis during the critical period of visual system maturation is essential to prevent amblyopia that could otherwise unfavorably impact a child's visual development. Although once contraindicated in children,[8] penetrating keratoplasty is now the treatment of choice for a carefully selected group of infants and children with corneal opacities due to a variety of etiologies. The less favorable outcomes of the transplants in children compared with adults stem from unique pre-, intra- and post-operative problems. The frequent presence of coexisting ocular pathology often necessitates a more complex surgical approach. Delayed awareness and treatment of postoperative problems arise from the inherent inability of young children to communicate their symptoms and limited examinations. Amblyopia often develops, despite a clear visual axis, due to difficult postoperative visual rehabilitation.[9,10,11,12,13,14,15,16] However, despite these obstacles, successful outcomes with respect to graft survival and visual restoration have been reported in a substantial percentage of cases.[9,10,12,13,15,16,17]

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