Keratoplasty in Infants and Children
Mohab Mounir Kamel Fadel;
Abstract
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 multispeciality transplant team and the education and cooperation of the patient's family are imperative for a successful outcome.
Successful pediatric corneal transplantation depends on the selection of an appropriate patient. A comprehensive history, thorough ophthalmic examination and often other ancillary tests are required to decide either to do penetrating keratoplasty or an alternative treatment.
The cornea was one of the first successful allografts using human tissue. Corneal transplantation involves removing the diseased cornea and replacing it with a new cornea (from a cadaver).
The success rate of penetrating keratoplasty in children is not as high as it is in adults, but the results are more encouraging nowadays. The reasons for the poorer prognosis are technically difficult surgery and resultant irreversible amblyopia.
The importance of postoperative care in pediatric keratoplasty cannot be overemphasized and often requires further examination under anesthesia, particularly in young children and infants.
Allograft rejection is much more common in children than adults, possibly due to a more active immune system in younger patients.
Corneal transplantation is only the first step in visual rehabilitation. Virtually all infants and children who have undergone keratoplasty have some degree of amblyopia because of either visual deprivation prior to surgery, graft astigmatism, anisometropia or a combination of these. The efficacy of amblyopia therapy during patients' first years of life establishes the eye's lifelong visual potential.
The visual outcome after pediatric keratoplasty is not always proportionate with what would be expected from observed graft survival rates. Poor visual outcome in a clear graft is well recognized and usually attributed to the development of amblyopia, the presence of coexisting ocular morbidity and postoperative astigmatism. Nonetheless, approximately 50% of infants and young children who undergo penetrating keratoplasty for congenital corneal opacities gain functional vision, which is defined as the ability to count fingers or perform more complex tasks.
Successful pediatric corneal transplantation depends on the selection of an appropriate patient. A comprehensive history, thorough ophthalmic examination and often other ancillary tests are required to decide either to do penetrating keratoplasty or an alternative treatment.
The cornea was one of the first successful allografts using human tissue. Corneal transplantation involves removing the diseased cornea and replacing it with a new cornea (from a cadaver).
The success rate of penetrating keratoplasty in children is not as high as it is in adults, but the results are more encouraging nowadays. The reasons for the poorer prognosis are technically difficult surgery and resultant irreversible amblyopia.
The importance of postoperative care in pediatric keratoplasty cannot be overemphasized and often requires further examination under anesthesia, particularly in young children and infants.
Allograft rejection is much more common in children than adults, possibly due to a more active immune system in younger patients.
Corneal transplantation is only the first step in visual rehabilitation. Virtually all infants and children who have undergone keratoplasty have some degree of amblyopia because of either visual deprivation prior to surgery, graft astigmatism, anisometropia or a combination of these. The efficacy of amblyopia therapy during patients' first years of life establishes the eye's lifelong visual potential.
The visual outcome after pediatric keratoplasty is not always proportionate with what would be expected from observed graft survival rates. Poor visual outcome in a clear graft is well recognized and usually attributed to the development of amblyopia, the presence of coexisting ocular morbidity and postoperative astigmatism. Nonetheless, approximately 50% of infants and young children who undergo penetrating keratoplasty for congenital corneal opacities gain functional vision, which is defined as the ability to count fingers or perform more complex tasks.
Other data
| Title | Keratoplasty in Infants and Children | Other Titles | تـرقيــــع القـ¬¬ــــــرنية فــى الأطفـــــال | Authors | Mohab Mounir Kamel Fadel | Issue Date | 2016 |
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