Pediatric Keratoplasty
Pediatric Keratoplasty
Corneal opacities in the pediatric population pose a great challenge for corneal specialists due to the difficulties in surgical management in the pre-, intra- or post-operative periods. Poor prognostic categories include congenital opacities, anterior-segment dysgeneses, such as Peters anomaly type 2, and other concomitant ocular disorders, such as glaucoma or lens abnormalities. While the decision to perform pediatric penetrating keratoplasty needs to be made circumspectly, it should not be delayed when appropriate. At present, anatomical success rates of pediatric corneal transplantation are increasing, particularly in older children with acquired corneal opacification, whereas visual success continues to remain less than desirable, particularly in infants with congenital opacification. To achieve optimal visual results and avoid amblyopia, surgical intervention should be performed within the first few months of the onset of corneal opacity, and accompanied by immediately intensive optical correction with amblyopia therapy. A team approach that involves multispecialty ophthalmologists, the pediatrician, the anesthesiologist and, perhaps most importantly, the family, is necessary to maintain a clear graft and optimize the chances of attaining a successful visual outcome.
Corneal opacities in the pediatric population pose a great challenge for corneal specialists due to the difficulties in surgical management in the pre-, intra- or post-operative periods. Poor prognostic categories include congenital opacities, anterior-segment dysgeneses, such as Peters anomaly type 2, and other concomitant ocular disorders, such as glaucoma or lens abnormalities. While the decision to perform pediatric penetrating keratoplasty needs to be made circumspectly, it should not be delayed when appropriate. At present, anatomical success rates of pediatric corneal transplantation are increasing, particularly in older children with acquired corneal opacification, whereas visual success continues to remain less than desirable, particularly in infants with congenital opacification. To achieve optimal visual results and avoid amblyopia, surgical intervention should be performed within the first few months of the onset of corneal opacity, and accompanied by immediately intensive optical correction with amblyopia therapy. A team approach that involves multispecialty ophthalmologists, the pediatrician, the anesthesiologist and, perhaps most importantly, the family, is necessary to maintain a clear graft and optimize the chances of attaining a successful visual outcome.
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