Pediatric Penetrating Keratoplasty

Lee, Olivia A.; Lenhart, Phoebe D.; Stulting, R. Doyle

doi:10.1016/b978-0-323-06387-6.00132-x

Cited by 5 publications

(3 citation statements)

References 64 publications

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“…Because of the increased elasticity of the infant cornea and sclera, it is recommended that the diameter of the donor tissue be 0.5-1.0 mm larger than the recipient opening. 23 In the current study, 95.8% of the cases had a graft-host disparity within this range. Also, there was a signi cant correlation between the graft size and the recipient corneal size (p=0.005).…”

Section: Discussionmentioning

confidence: 46%

Anterior Synechiae After Penetrating Keratoplasty In Infants And Children With Peters’ Anomaly

Yang

Xiang

2022

Preprint

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Purpose: To evaluate anterior synechiae (AS) after penetrating keratoplasty (PK) in patients with Peters’ anomaly using anterior segment optical coherence tomography (OCT). Methods: A retrospective cross-sectional study was performed. The medical records of patients diagnosed with Peters anomaly who underwent PK between 2013 and 2018 were reviewed. In addition to basic ophthalmic examinations, images of anterior segment structures were obtained via spectral-domain OCT at baseline and during the postoperative follow-up period. The profiles of postoperative AS and multiple potential risk factors were analyzed.Results: Seventy-one eyes of 58 patients, aged 5 to 23 months, were included. Various extent of postoperative AS were observed in 59 eyes (83.1%). OCT findings revealed graft-host junction synechiae, peripheral anterior synechiae and a combination of both. Disease severity and malapposition of the internal graft-host junction (GHJ) were significantly associated with the formation of postoperative AS. Multivariate regression analysis found that preexisting iridocorneal adhesion (ICA) (odds ratio [OR]=16.639, 95% confidence interval [CI] 1.494-185.294, p=0.022) was positively correlated with postoperative AS, whereas anterior chamber depth (OR=0.009, 95% CI 0.000-0.360, p=0.012), and graft size (OR=0.016, 95% CI 0.000-0.529, p=0.020) were negatively correlated with postoperative AS. In addition, quadrants of preexisting ICA and the width of the host corneal bed were identified as risk factors for increased postoperative AS.Conclusions: Postoperative AS is a relatively common occurrence in Peters’ anomaly patients following PK and is found to be associated with preexisting ICA, a shallow anterior chamber, small graft size, GHJ malappositions and grafts closer to the corneal limbus. These data indicate the need for careful consideration when performing PK on these patients.

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Section: Discussionmentioning

confidence: 46%

Anterior Synechiae After Penetrating Keratoplasty In Infants And Children With Peters’ Anomaly

Yang

Xiang

2022

Preprint

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“…A common timetable is 4 to 6 weeks in children younger than 1 year, 6 to 8 weeks in 1-to 2-yearolds, 8 to 12 weeks for 2-to 3-year-olds, and 12 to 16 weeks in children aged 4 to 6 years. 15 The schedule for older children is similar to that of adults. A loose suture needs to be removed immediately, as it may trap mucus, irritate the eye, serve as a nidus for infection, and increase the risk of graft rejection.…”

Section: Postoperative Managementmentioning

confidence: 91%

Pediatric Penetrating Keratoplasty

O’Hara

Mannis

2013

International Ophthalmology Clinics

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The first successful penetrating keratoplasty was performed in 1905 by Eduard Zirm. 1 The donor for this transplant was an 11-year-old boy and the recipient a 45-year-old adult. Zirm's successful surgery was the basis for elaborating the basic principles of successful penetrating keratoplasty and ushered in an era of innovation and improvement in surgical outcomes. However, corneal transplantation with a child as the recipient has proved considerably more challenging. Before the 1970s, pediatric penetrating keratoplasty (PPK) was recommended only for older children or in children with severe bilateral disease. 2 PPK presents a unique set of surgical challenges. The young child's eye is smaller and the sclera and cornea are less rigid, making tissue sizing and apposition more difficult. Moreover, positive posterior vitreous pressure encountered in PPKs can cause significant anterior displacement of the lens-iris diaphragm during ''open sky'' surgery. The brisk inflammatory response of pediatric eyes to surgery can increase the risk of scarring, rejection, cataract, and glaucoma. In addition, many pediatric eyes coming to transplant harbor congenital anomalies that further confound the surgery.Postoperative management of the PPK also differs in that frequent examinations are necessary, commonly under general anesthesia. Parents must be prepared carefully to assume their responsibilities in a demanding postoperative regimen. Sutures are adjusted and removed much earlier than in the adult patient, requiring anesthesia in the young child. Treatment of amblyopia and close attention to refractive correction is also critical to the visual outcome.These special considerations necessitate a team approach that is distinctly different from keratoplasty in the adult. Collaboration between

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“…Parents should be explained that allograft rejection might occur any time after surgery. Neonates and infants should be closely monitored for development of allograft rejection in the first year of life as graft failure occurs most frequently during this period (Lee et al, 2016;Hutcheson 2007). Pediatric patients have tendency for more postoperative inflammation, increasing the risk of synechiae formation and rejection (O'Hara & Mannis 2013;Vanathi et al, 2009;Reidy 2001).…”

Section: Allograft Rejectionmentioning

confidence: 99%

Pediatric Corneal Transplant Surgery: Challenges for Successful Outcome

Sharma

Sharma²

2019

Nep J Oph

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Visual rehabilitation of pediatric corneal blinds is a major challenge to corneal transplant surgeons. Penetrating keratoplasty (PKP) is the only way to restore vision and prevent irreversible blindness due to amblyopia in children. Performing penetrating corneal grafts in children poses difficulty in evaluation, technical difficulties during surgery and problems during follow-up. Younger children do not cooperate for proper slit-lamp examination and need to be examined under general anaesthesia. In addition, the complications encountered post PKP, including allograft rejection, post PKP astigmatism and post PKP glaucoma are more frequent in pediatric group as compared to adult recipients. Even after a successful graft, the child requires rigorous treatment for amblyopia. Parents need to be counselled before surgery and possible visual outcome and chances of obtaining clear graft should be discussed.

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Pediatric Penetrating Keratoplasty

Cited by 5 publications

References 64 publications

Anterior Synechiae After Penetrating Keratoplasty In Infants And Children With Peters’ Anomaly

Anterior Synechiae After Penetrating Keratoplasty In Infants And Children With Peters’ Anomaly

Pediatric Penetrating Keratoplasty

Pediatric Corneal Transplant Surgery: Challenges for Successful Outcome

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