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Chapter-64 An Update on Pediatric Keratoplasty

BOOK TITLE: Surgical Techniques in Ophthalmology (Pediatric Ophthalmic Surgery)

Author
1. Panda Anita
2. Behera Geeta
3. Kumar Abhiyan
ISBN
9789350251485
DOI
10.5005/jp/books/11282_64
Edition
1/e
Publishing Year
2011
Pages
12
Author Affiliations
1. Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, Rajendra Prasad Centre for Ophthalmic Sciences, AIIMS Ansari Nagar, New Delhi, India, Dr RP Centre for Ophthalmic Sciences, AIIMS, Ansari Nagar, New Delhi-110029, India, Dr RP Centre for Ophthalmic Sciences AIIMS, Ansari Nagar, New Delhi, RP Centre of Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences (AIIMS), New Delhi, India, Dr RP Center for Ophthalmic Sciences, AIIMS, Ansari Nagar, New Delhi, India, Dr RP Centre for Ophthalmic Sciences, AIIMS, New Delhi, India, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India, Dr RP Centre for Ophthalmic Sciences, All India Institute of Medical Sciences (AIIMS), New Delhi, India
2. Dr RP Centre for Ophthalmic Sciences, All India Institute of Medical Sciences (AIIMS), New Delhi, India, Dr RP Center for Ophthalmic Sciences, AIIMS, Ansari Nagar, New Delhi, India, Dr RP Centre for Ophthalmic Sciences, AIIMS, Ansari Nagar New Delhi-110029, India
3. Dr RP Centre for Ophthalmic Sciences, All India Institute of Medical Sciences (AIIMS), Ansari Nagar, New Delhi, India, Dr RP Center for Ophthalmic Sciences, AIIMS, Ansari Nagar, New Delhi, India, Dr RP Centre for Ophthalmic Sciences, AIIMS, New Delhi, India, Dr RP Centre for Ophthalmic Sciences, AIIMS Ansari Nagar, New Delhi, India
Chapter keywords

Abstract

Penetrating keratoplasty may be the necessary first step in preventing irreversible loss of visual function in a child, though the visual results of pediatric penetrating keratoplasty have been fairly disappointing. Measuring the vision can be performed either directly or indirectly. All surgery is carried out under general anesthesia. The surgery itself is technically more difficult because in infants, the cornea and the anterior chamber are smaller, and the cornea is often thinner and more pliable, requiring more exacting surgical technique. Infants and children in comparison to adults, appear to be more prone to a severe inflammatory response during the early postoperative period and more likely to have endothelial graft rejection or graft failure. Of the congenital anomalies, Peter’s anomaly, sclerocornea and congenital glaucoma have a particularly poor chance of success, while patients with posterior polymorphous dystrophy and congenital hereditary endothelial dystrophy fare better. In infants, the cornea and anterior segment are smaller, and the cornea is often thinner and more pliable, making the surgery technically more difficult. Continuous sutures may be preferred in a symmetric vascular or avascular opacity, but never in an asymmetric vascular opacity or infected case. Postoperative care is necessary for early recovery. Without effective optical correction and amblyopia therapy, a pediatric penetrating keratoplasty may be useless. Contact lens is useful in the visual rehabilitation of pediatric keratoplasty patients. Although pediatric penetrating keratoplasty patients are among the most challenging, the corneal surgeon will encounter, they can also be among the most rewarding. With a great deal of effort the vision of an infant or a child, otherwise condemned to lifelong blindness, can be restored.

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