Pediatric Keratoplasty

Abstract

Penetrating keratoplasty in children is a highly challenging and demanding procedure associated with a high risk of graft failure or failure of amblyopia therapy in clear grafts. Nonetheless, keratoplasty remains the surgery of choice for the management of pediatric corneal stromal opacities or edema. Allograft rejection, graft infection, corneal neovascularization, glaucoma, trauma to the anterior segment, vitreous pathology, and additional surgical interventions, especially those related to glaucoma management, are important risk factors. Successful penetrating keratoplasty in children requires careful preoperative evaluation and selection of patients follow-up by well-motivated parents, an expert corneal transplant surgeon, and a devoted pediatric ophthalmologist.

Combined anterior and posterior segment injuries in children: a review

“…Perforating keratoplasties in children following trauma have a poorer general prognosis, especially in cases of aphakia and after injuries involving the posterior segment of the eye, as opposed to phakic eyes and after isolated injuries to the anterior segment. In a meta-analysis [42], 70% to 100% of transplants were not opaque 1 year after keratoplasty in children (Table 6).…”

Management of inflammatory corneal melt leading to central perforation in children: a retrospective study and review of literature

“…There are numerous medical and surgical options for managing corneal perforation, but surgical procedures in children are technically more difficult than adults. 20 The strategy for managing corneal perforation should address the underlying process leading to keratolysis as well as the surgical aspect to restore the integrity of the globe and useful vision. It is our suggestion that the welldocumented increased inflammatory response seen in children should also have some consideration in the decision-making algorithm.…”

Descemet stripping automated endothelial keratoplasty in a child after failed penetrating keratoplasty

“…Graft success rate in pediatric PK is lower when compared with PK in adults and further decreases with every successive repeat keratoplasty. 8 Furthermore, patients are again at risk of suture-related complications, delayed visual recovery (which increases the risk of amblyopia), induced anisometropic astigmatism, and unstable wounds. DSAEK has been seen to be a preferable option after failed PK for visual restoration when the PK graft has an acceptable topography and vision preoperatively without significant stromal scarring.…”