Pediatric keratoplasty.

Cornea and Refractive Surgery Services, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India.
Survey of Ophthalmology (Impact Factor: 2.86). 01/2009; 54(2):245-71. DOI: 10.1016/j.survophthal.2008.12.011
Source: PubMed

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.

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    ABSTRACT: To evaluate the long-term corneal graft survival and risk factors for graft failure in pediatric eyes.
    American journal of ophthalmology. 05/2014;
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    ABSTRACT: The aim of this study was to investigate the usefulness and tolerance of rigid gas-permeable (RGP) contact lenses in the visual rehabilitation of children postocular trauma. In this retrospective case series, children below 15 years of age with ocular trauma were included. The best-corrected visual acuity with RGP contact lenses was compared with that of spectacle correction. The factors affecting visual improvement were analyzed, and problems caused by contact lens use were identified. Twelve eyes of 12 boys were included. The mean best-corrected visual acuity was 0.81 ± 0.29 (LogMar equivalent) with spectacles and 0.47 ± 0.27 (LogMar equivalent) with contact lenses (P < 0.001). Seven of the 12 eyes achieved a >2 line increase in visual acuity with contact lens correction as compared with that using spectacle correction. The mean astigmatism in eyes that achieved this improvement in vision was 5.45 ± 1.6 diopters, whereas the mean astigmatism in the eyes that did not improve was 2.6 ± 1.2 diopters, which was statistically significant (P = 0.009). No other factors (age, corneal scar location/density, grade/zone of injury, lens status, and occlusion) seemed to affect visual improvement with contact lenses. The mean follow-up duration was about 15 months during which 91% of the patients continued their contact lens usage. RGP contact lenses offer a useful refractive treatment alternative in traumatized eyes of children. Eyes with high degrees of astigmatism were found to benefit the most. RGP contact lenses were found to be well tolerated in this population.
    Cornea 03/2014; · 1.75 Impact Factor
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    ABSTRACT: To investigate and compare the clinical outcome of primary penetrating keratoplasty in pediatric patients with Peters anomaly and sclerocornea. Medical records of 20 eyes of 18 patients with Peters anomaly or sclerocornea who underwent primary penetrating keratoplasty when they were 5 years or younger were reviewed. The survival rates and median survival times of corneal grafts were evaluated to determine the surgical outcome. Demographics of patients, the preoperative characteristics of recipient eyes, surgical procedures, causes of graft failure, and postoperative complications were analyzed to identify the factors affecting graft survival. A total of 20 penetrating keratoplasties were performed in 18 patients. Eight patients had Peters anomaly, and 10 patients had sclerocornea. Overall, 50% of corneal grafts survived during the follow-up of 92.7 ± 10 months. The graft survival was 65% at 6 months and remained 50% at 12 months, 2 years, and 5 years after surgery. The mean survival time and survival rate were significantly different between patients with Peters anomaly and those with sclerocornea (the survival time, 135.6 ± 17.9 vs. 36.4 ± 16.1 months, P = 0.014; the survival rate, 87.5% vs. 25.0%, P = 0.02). The presence of opacity or vascularization in the limbus and in the peripheral cornea and the diameter of the recipient cornea were significantly correlated with graft failure. Penetrating keratoplasty in patients who were 5 years or younger had an excellent surgical outcome in patients with Peters anomaly, whereas the graft survival was poor in patients with sclerocornea.
    Cornea 11/2013; 32(11):1432-1436. · 1.75 Impact Factor