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Sun Y, Lin Q, Song P, Li X, Pan Z. Clinical Analysis of Repeat Penetrating Keratoplasty in Children. J Clin Med 2023; 12:jcm12093346. [PMID: 37176786 PMCID: PMC10179216 DOI: 10.3390/jcm12093346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 04/07/2023] [Accepted: 04/28/2023] [Indexed: 05/15/2023] Open
Abstract
(1) Background: To analyze the indications, graft survival, and graft failure-related risk factors of repeat penetrating keratoplasty (RPK) in children. (2) Methods: In this case series, children younger than 12 years who received RPK at Beijing Tongren Hospital were reviewed. The indications for RPK, postoperative complications, and graft survival were analyzed. The analysis of the potential variables associated with graft survival was performed using Cox proportional hazards regression. (3) Results: A total of 30 RPK eyes of 29 children were included in this study. The mean follow-up time was 26.98 ± 18.75 months. The most common indication for RPK was a vascularized corneal scar (86.67%). Postoperative complications occurred in 27 eyes (90%), including immune rejection (46.67%), epithelial defects (36.67%), and glaucoma (26.67%). About 60% of the regrafts remained clear one year after RPK, while the overall graft survival rate was 30% at the last visit. The most common cause of regraft failure was irreversible immune rejection (8/21). The significant risks of graft failure included an age of less than 60 months at surgery (p = 0.009), corneal vascularization (p = 0.018), and a postoperative epithelial defect (p = 0.037). (4) Conclusions: A vascularized corneal scar is the most common indication of RPK in children. Immune rejection is the most prevalent complication, and irreversible immune rejection always causes regraft failure.
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Affiliation(s)
- Yajie Sun
- Department of Ophthalmology, Henan Provincial People's Hospital, Henan Eye Institute, Zhengzhou 450003, China
| | - Qi Lin
- Department of Ophthalmology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
| | - Peng Song
- Department of Ophthalmology, Henan Provincial People's Hospital, Henan Eye Institute, Zhengzhou 450003, China
| | - Xu Li
- Beijing Ophthalmology & Visual Science Key Laboratory, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing 100005, China
| | - Zhiqiang Pan
- Beijing Ophthalmology & Visual Science Key Laboratory, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing 100005, China
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Abstract
BACKGROUND Peters' anomaly (PA) is the most commonly encountered congenital corneal opacity (CCO) and displays a wide phenotypical range. The relatively recent adoption of high-quality anterior segment imaging in the form of high-frequency ultrasound biomicroscopy and anterior segment optical coherence tomography has aided in the accurate diagnosis of CCOs, facilitated distinction of PA from "pseudo-Peters' anomaly," and aided in prognostication and surgical risk stratification in PA. While the definitive management of PA, especially the more severe forms, is penetrating keratoplasty (PK), long-term success rates have overall been disappointing. This spurred the development of more non-invasive procedures, such as optical iridectomy and the more recently described selective endothelial removal, which represent viable alternatives to PK, at least in the less severe phenotypes of PA. METHODS Literature searches for the components of this review were performed using PubMed, in September 2021. The following keywords and their iterations were employed for the searches: "Peters' anomaly," "anterior segment dysgenesis," "kerato-irido-lenticular dysgenesis," "congenital corneal opacities." These were entered into the PubMed search engine, revealing 2852 related articles. The inclusion criteria included publications in the English language, specific to Peters' anomaly. Fifty-five studies that were published as systematic reviews or as nonrandomized comparative studies (cohort or case series) on the topic of Peters' anomaly were finally selected for this review. RESULTS This review provides a summary of Peters' anomaly in the context of advances in diagnosis, classification, and genotype-phenotype correlation of congenital corneal opacities, with a focus on penetrating keratoplasty, its outcomes, and non-invasive surgical options. While conservative therapies such as spontaneous clearing, mydriatic eye drops, and optical iridectomy may have variable success in milder variants of PA, penetrating keratoplasty in these eyes is fraught with several challenges and typically results in poor long-term functional outcomes. The management strategy depends on several variables such as phenotypical severity of PA, laterality, age at presentation, and capacity to adhere to the follow-up schedule. Notwithstanding the choice of treatment, it is essential that early and aggressive amblyopia therapy, a thorough systemic examination, and appropriate referral are undertaken for all patients of PA. CONCLUSION Peters' anomaly has seen recent advances in diagnosis, but treatment options remain limited. Focus directed towards less-invasive alternatives to keratoplasty may yield better functional outcomes.
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Affiliation(s)
- Raksheeth Nathan Rajagopal
- Academy for eye care education, L V Prasad Eye Institute, Hyderabad, India
- Cornea and Anterior Segment Service, The Cornea Institute, L V Prasad Eye Institute, Hyderabad, India
| | - Merle Fernandes
- Cornea and Anterior Segment Service, The Cornea Institute, L V Prasad Eye Institute, Hyderabad, India
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Ramappa M, Chaurasia S, Mohamed A, Ramya Achanta DS, Mandal AK, Edward DP, Gokhale N, Swarup R, Nischal KK. Selective Endothelialectomy in Peters Anomaly: A Novel Surgical Technique and Its Clinical Outcomes in Children. Cornea 2022; 41:1477-1486. [PMID: 36198649 PMCID: PMC9640272 DOI: 10.1097/ico.0000000000003134] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 07/25/2022] [Accepted: 07/25/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE This study describes the surgical outcomes of selective endothelialectomy in Peters anomaly (SEPA), a relatively new technique to manage Peters anomaly (PA). METHODS This study included 34 eyes of 28 children who had a visually significant posterior corneal defect due to PA and underwent SEPA between 2012 and 2019. A selective endothelialectomy from the posterior corneal defect was performed while preserving Descemet membrane. The primary outcome measure was the resolution of corneal opacification. The secondary outcome measures were functional vision, complications, and risk factors for failure. RESULTS At a mean postoperative follow-up of 0.96 ± 0.20 years, 29 eyes (85.3%) maintained a successful outcome. Mean preoperative and postoperative best-corrected visual acuities were 2.55 ± 0.13 and 1.78 ± 0.13 ( P < 0.0001), respectively. Ambulatory functional visual improvement was seen in 97%, and 23% attained vision ranging between 20/190 and 20/50. Corneal opacification failed to clear in 5 eyes (15%). Risk factors associated with surgical failure were female sex ( P = 0.006), disease severity ( P < 0.0001), glaucoma ( P = 0.001), and additional interventions after SEPA ( P = 0.002). In multivariate analysis, only disease severity (ie, a type 2 PA) was a significant risk factor for the failure of SEPA. There were no sight-threatening complications. CONCLUSIONS SEPA is a safe and effective technique in select cases of posterior corneal defect due to PA. SEPA could be a potential surgical alternative to pediatric keratoplasty or optical iridectomy in children with central corneal opacification smaller than 7 mm due to PA.
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Affiliation(s)
- Muralidhar Ramappa
- Institute for Rare Eye Diseases and Ocular Genetics, L V Prasad Eye Institute, Hyderabad, India
- The Cornea Institute, L V Prasad Eye Institute, Hyderabad, India
- Jasti V Ramanamma Children's Eye Care Center, L V Prasad Eye Institute, Hyderabad, India
| | - Sunita Chaurasia
- Institute for Rare Eye Diseases and Ocular Genetics, L V Prasad Eye Institute, Hyderabad, India
- The Cornea Institute, L V Prasad Eye Institute, Hyderabad, India
- Jasti V Ramanamma Children's Eye Care Center, L V Prasad Eye Institute, Hyderabad, India
| | - Ashik Mohamed
- Institute for Rare Eye Diseases and Ocular Genetics, L V Prasad Eye Institute, Hyderabad, India
- Ophthalmic Biophysics, L V Prasad Eye Institute, Hyderabad, India
| | - Divya Sree Ramya Achanta
- Institute for Rare Eye Diseases and Ocular Genetics, L V Prasad Eye Institute, Hyderabad, India
- The Cornea Institute, L V Prasad Eye Institute, Hyderabad, India
- Jasti V Ramanamma Children's Eye Care Center, L V Prasad Eye Institute, Hyderabad, India
| | | | - Deepak Paul Edward
- Department of Ophthalmology and Visual Sciences and Pathology, University of Illinois College of Medicine, Chicago, IL
| | | | | | - Ken K. Nischal
- UPMC Eye Center, Children's Hospital of Pittsburgh, Pittsburgh, PA; and
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA
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Miao S, Lin Q, Li X, Zhao L, Pan Z. Possible association between viral infection and poor survival of the corneal graft after penetrating keratoplasty in patients with congenital corneal opacity: a cohort study. Br J Ophthalmol 2022; 107:763-768. [PMID: 35027353 DOI: 10.1136/bjophthalmol-2021-320031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 01/03/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Congenital corneal opacity (CCO) is a rare disorder. Penetrating keratoplasty (PK) is the main surgical option for CCO, but many factors affect graft survival. Therefore, this study aimed to perform a virological examination of CCO specimens after PK to explore the relationship between virological factors and graft survival after PK. METHODS This prospective study included consecutive patients (<6 months of age) diagnosed with CCO and treated with PK at Beijing Tongren Hospital from August 2017 to January 2018. Next-generation sequencing was used to detect viral DNA in the CCO specimens. The survival of the primary graft was analysed using the Kaplan-Meier method. RESULTS Overall, 24 eyes of 24 infants were treated with PK during the study period. The mean age at surgery was 4.8±1.1 months. Epstein-Barr virus DNA was detected in two specimens, varicella-zoster virus DNA in one specimen, herpes simplex virus DNA in three specimens and cytomegalovirus DNA in one specimen. In the virus-positive group, only one (14.3%) graft remained clear during follow-up. In contrast, in the virus-negative group (n=17), 13 (76.5%) grafts were still clear at the last follow-up. The mean survival of the grafts in the virus-positive group was significantly shorter than in the virus-negative group (11.0±9.8 months vs 27.1±7.7, p<0.001). CONCLUSION The presence of viral DNA in CCO specimens might be associated with poor graft survival after PK.
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Affiliation(s)
- Sen Miao
- Department of Ophthalmology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Qi Lin
- Department of Ophthalmology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Xu Li
- Department of Ophthalmology, Beijing Ophthalmology and Visual Science Key laboratory, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical Unversity, Beijing, China
| | - Lu Zhao
- Department of Ophthalmology, Beijing Ophthalmology and Visual Science Key laboratory, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical Unversity, Beijing, China
| | - Zhiqiang Pan
- Department of Ophthalmology, Beijing Ophthalmology and Visual Science Key laboratory, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical Unversity, Beijing, China
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Penetrating Keratoplasty in Infants With Peters Anomaly: Visual and Graft Outcomes. Cornea 2021; 40:720-725. [PMID: 33941716 DOI: 10.1097/ico.0000000000002669] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Accepted: 12/12/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE To determine the prevalence of survival of corneal grafts and visual outcomes of primary penetrating keratoplasty (PK) in infants with Peters anomaly (PA) in Beijing, China. METHODS Twenty-nine patients (37 eyes) with PA who underwent PK before the age of 1 year were included. Optical correction for all eyes and occlusion therapy of amblyopia for a unilateral opacity were performed 2 weeks after suture removal. All infants underwent assessment of visual acuity after surgery using Teller Acuity Cards. Survival probabilities were estimated using the Kaplan-Meier method and log-rank test. Visual outcomes and prognosis factors were analyzed using the χ2 test. RESULTS The mean age of 29 infants undergoing primary PK was 5.7 ± 2.3 months. The mean follow-up duration was 18.0 ± 3.0 months. Twenty-seven (73.0%) of 37 grafts retained full clarity at final follow-up. Visual acuity above ambulatory was achieved in 67.6% (25/37) and >20/260 was achieved in 48.6% (18/37) of cases. Of all surgical indications, vascularized PA I (50.0%, 6/12) and PA II (18.2%, 2/11) showed a lower proportion achieving visual acuity >20/260 than nonvascularized PA I (71.4%, 10/14) (P = 0.030 < 0.05). There was no significant difference in the prevalence of graft survival and vision outcome between infants younger than 6 months and older than >6 months. CONCLUSIONS For infants with PA who underwent PK, the prevalence of graft survival and visual acuity were related mainly to the indication. The main risk factors were corneal vascularization and an abnormal lens.
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Pohlmann D, Rossel M, Salchow DJ, Bertelmann E. Outcome of a penetrating keratoplasty in a 3-month-old child with sclerocornea. GMS OPHTHALMOLOGY CASES 2020; 10:Doc35. [PMID: 32884889 PMCID: PMC7452949 DOI: 10.3205/oc000162] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Sclerocornea is a rare congenital anomaly with clouding of the peripheral cornea that possibly extends up to the center of the cornea. Characteristically, a clear distinction (limbus) between sclera and cornea is lacking. Early surgical treatment is essential for preventing amblyopia, but penetrating keratoplasty in children carries a relatively high risk of complications. Especially for sclerocornea, penetrating keratoplasty has generally been reported to have a poor surgical outcome and a high risk of complications, including corneoscleral adhesions. Here, we report the 4-year follow-up on a child with sclerocornea, who was successfully operated on at the age of 3 months and had a favorable outcome. Our findings suggest that in some cases, penetrating keratoplasty may be an option to treat sclerocornea in young children.
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Affiliation(s)
- Dominika Pohlmann
- Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany,*To whom correspondence should be addressed: Eckart Bertelmann, Department of Ophthalmology, Charité – Universitätsmedizin Berlin, Campus Virchow, Augustenburger Platz 1, 13353 Berlin, Germany, Phone: +49 30 450 554202, Fax: +49 30 450 554900, E-mail:
| | - Mirjam Rossel
- Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Daniel J. Salchow
- Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Eckart Bertelmann
- Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany,*To whom correspondence should be addressed: Eckart Bertelmann, Department of Ophthalmology, Charité – Universitätsmedizin Berlin, Campus Virchow, Augustenburger Platz 1, 13353 Berlin, Germany, Phone: +49 30 450 554202, Fax: +49 30 450 554900, E-mail:
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Abstract
PURPOSE To explore the transition of indications and surgical techniques of pediatric keratoplasty in Eastern China in the past 10 years. METHODS Medical charts of 1026 pediatric patients (1059 eyes) who underwent keratoplasties at the Eye, Ear, Nose and Throat Hospital of Fudan University from 2008 to 2017 were retrospectively reviewed. The indications for keratoplasty and the surgical techniques were collected and analyzed. RESULTS A total of 634 infants (≤3 years) (661 eyes), 207 toddlers and older children (4-12 years) (211 eyes), and 185 adolescents (13-18 years) (187 eyes) were included. The median age at the time of surgery was 2 years. The surgical indications were composed of congenital abnormalities (74.6%), acquired nontraumatic diseases (16.5%), acquired traumatic diseases (3.6%), and regraft (5.3%). Only congenital abnormality had a significant growing trend during this decade (P = 0.023). Keratoconus (67.2%) exceeded infectious keratitis (14.9%) and was the most common acquired nontraumatic cause in our study. The annual number of pediatric keratoplasties increased significantly from 40 cases in 2008 to 190 cases in 2017 (P < 0.001). Although penetrating keratoplasty was performed in 414 eyes (39.1%), its application in the treatment of keratoconus decreased significantly during this decade (P = 0.04). By contrast, deep anterior lamellar keratoplasty showed an increasing trend because of its popularization in the treatment of keratoconus (P = 0.003). CONCLUSIONS Congenital abnormalities have replaced infectious keratitis and have been the leading indications of pediatric keratoplasty in the past 10 years. Although the using of penetrating keratoplasty was still the predominant procedure to treat pediatric corneal pathologies, the adoption of deep anterior lamellar keratoplasty showed a significant increasing trend during the past decade.
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Abstract
Penetrating keratoplasty in children is associated with very specific difficulties for the surgeon as well as for the patient and the parents. Special features are specific pediatric indications, which do not occur in adults, a more difficult examination and treatment adherence depending on the parents. Diseases with a favorable prognosis include keratoconus and herpetic keratitis. Especially sclerocornea and the Peters' anomaly often have a limited prognosis regarding vision and graft survival due to secondary malformations of the eye. In addition, younger age represents a risk factor. This is most likely due to the impaired examination during follow-up and reduced compliance. For successful penetrating keratoplasty in children the timing for the operation, in which the risk for the graft is weighed up against the risk for amblyopia, is crucial.
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Affiliation(s)
- S J Lang
- Klinik für Augenheilkunde, Medizinische Fakultät, Universitätsklinikum Freiburg, Kilianstr. 5, 79106, Freiburg, Deutschland.
| | - D Böhringer
- Klinik für Augenheilkunde, Medizinische Fakultät, Universitätsklinikum Freiburg, Kilianstr. 5, 79106, Freiburg, Deutschland
| | - T Reinhard
- Klinik für Augenheilkunde, Medizinische Fakultät, Universitätsklinikum Freiburg, Kilianstr. 5, 79106, Freiburg, Deutschland
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Abstract
PURPOSE Corneal transplantation is the standard of care for pediatric corneal opacities, but little consensus exists on optimal surgical management. Our goal was to evaluate cross-sectional data of donor and recipient characteristics collected from eye banks providing tissue for pediatric corneal transplant cases to assess surgical trends in pediatric keratoplasty over the past 13 years. METHODS We performed a retrospective review of recipient data, collected from 4 major eye banks, for pediatric patients (<18 years) who underwent corneal transplantation between January 2005 and December 2017. We analyzed trends in surgical indications, types of keratoplasty, and donor/recipient characteristics. RESULTS Our database included 2620 total pediatric cases. Penetrating keratoplasty (PKP) remains the most common surgery performed (79.8%), but more partial-thickness transplant cases [eg, endothelial keratoplasty (EK)] have been performed since 2008. The most commonly reported transplant indication was ectasias/thinnings (34.1%) overall and congenital opacities (17.0%) in children less than 5 years. Average donor age was significantly lower for the youngest recipient age group of less than 5 years (P < 0.001); endothelial cell count was also higher, and death-to-surgery time was lower for PKP and EK cases versus other keratoplasties. CONCLUSIONS Indications for transplant vary across age groups but are consistent with previous reports. Popularity of partial-thickness transplants has increased since 2008. Surgeons prefer younger donor tissue for younger patients and have higher thresholds for endothelial cell count for PKP and EK cases. Centralized tracking of pediatric keratoplasty cases is necessary for further investigation of long-term outcomes.
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Moein HR, Saeed HN, Jacobs DS, Rapoport Y, Yoon MK, Shah AS, Khan H, Raoof D, Jurkunas UV. Exposure, entropion, and bilateral corneal ulceration in a newborn as a manifestation of chromosome 22 q11.2 duplication syndrome. Am J Ophthalmol Case Rep 2019; 13:16-19. [PMID: 30505980 PMCID: PMC6247406 DOI: 10.1016/j.ajoc.2018.11.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Revised: 10/08/2018] [Accepted: 11/02/2018] [Indexed: 01/24/2023] Open
Abstract
Purpose Chromosome 22q11.2 micro-duplication syndrome (MDS), is a rare autosomal dominant condition, with a highly variable phenotype that ranges from unremarkable and asymptomatic, to fatal due to cardiovascular defects. Hypertelorism, downslanting palpebral fissures, superior displacement of the eyebrows, and ptosis are the most commonly reported ocular manifestations. Here, we report a newborn with bilateral exposure, entropion, and corneal ulceration related to 22q11.2 MDS. Observation A newborn girl presented with bilateral upper eyelid entropion, bilateral lower eyelid ectropion, and lagophthalmos. She subsequently developed bilateral corneal ulcers. Topical antibacterial drops, bandage contact lenses, medroxyprogesterone 1%, and fluorometholone 0.1%, together with partial tarsorrhaphy and correction of eyelid malposition, were used to treat the ulcers and address the underlying issues of exposure and entropion. Genetic testing revealed chromosome 22q11.2.MDS; further evaluation revealed systemic manifestations of this syndrome. The ocular surface healed well with gradual improvement of corneal opacification as well as bilateral partial tarsorrhaphy. Conclusion and importance This report is the first that describes a newborn with 22q11.2 MDS presenting with sight-threatening corneal ulceration. Entropion, ectropion, and lagophthalmos were identified and treated, allowing for healing of the corneal surface. Genetic testing revealed a syndrome not known to be associated with eyelid abnormalities and corneal ulceration, but with other important systemic and ocular implications. Bilateral partial tarsorrhaphy should not be excluded as a treatment option for infants who fail more conservative measures for the treatment of exposure.
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Affiliation(s)
- Hamid-Reza Moein
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, MA, USA
| | - Hajirah N Saeed
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, MA, USA
| | - Deborah S Jacobs
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, MA, USA.,BostonSight, Needham, MA, USA
| | - Yuna Rapoport
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, MA, USA
| | - Michael K Yoon
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, MA, USA
| | - Ankoor S Shah
- Department of Ophthalmology, Boston Children's Hospital, Boston, MA, USA
| | - Haumith Khan
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, MA, USA
| | - Duna Raoof
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, MA, USA
| | - Ula V Jurkunas
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, MA, USA
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Abstract
PURPOSE To facilitate development of standardized guidelines for management of pediatric patients undergoing keratoplasty, particularly the youngest cohort, through a comprehensive survey assessing recent trends in practice patterns of corneal specialists and pediatric ophthalmologists. METHODS A cross-sectional, observational study of current practices pertaining to pediatric keratoplasty was performed by designing a 20-question survey focused on preoperative indications, surgical techniques, and postoperative management. This survey was sent electronically to corneal specialists and pediatric ophthalmologists. Results were compared with the findings of previous studies regarding pediatric keratoplasty. RESULTS Of the 80 ophthalmologists who responded, 51.3% currently perform pediatric keratoplasty; only 20% have performed >50 cases. The majority (73.8%) completed solely corneal fellowships; all perform penetrating keratoplasty, 35.2% also perform endothelial keratoplasty, and 37% also perform lamellar keratoplasty. Peters anomaly was the most common indication for transplantation (34.3%). The majority believe that 1 to 3 months is the optimal age range to perform keratoplasty for both monocular and binocular congenital corneal opacities, although 13% stated that they would never perform keratoplasty in a patient with a monocular opacity. All surgeons report modifying their intraoperative techniques for pediatric patients, but specific practices and postoperative management protocols vary. There is a consensus regarding the importance of amblyopia therapy in these patients. CONCLUSIONS Our results were consistent with the published literature regarding the indication and types of surgery performed. Variability among surgical techniques and postoperative management protocols highlights the necessity of creating standardized guidelines to optimize management of pediatric patients undergoing keratoplasty. Collaborative efforts between corneal and pediatric specialists are crucial for defining visual rehabilitation protocols to enhance visual outcomes.
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Bai L, Liang W, Chen M, Cissé Y, Liu J, Su Y, Yu J, Liu Q. Effect of lentivirus-mediated gene silencing, targeting toll-like receptor 2, on corneal allograft transplantation in rats. Mol Immunol 2017; 91:97-104. [DOI: 10.1016/j.molimm.2017.08.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2017] [Revised: 08/19/2017] [Accepted: 08/23/2017] [Indexed: 11/30/2022]
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