Corneal Transplantation in Children: A Closer Look

Restoring Vision and Hope: Corneal Transplantation in Children

The cornea, or the clear, dome-shaped front of the eye, collects and focuses light into the retina. If the cornea becomes damaged as the result of injury, disease, or congenital conditions, then eyesight can be very seriously affected. It is a surgery that replaces the cloudy or damaged cornea with a healthy donor cornea. Pediatric corneal transplant is such a specialized area treated at Madurai Eye Center in Coimbatore, restoring vision in its young patients.

Corneal transplantation in children, while challenging, can be a sight-saving procedure. Unlike adults, children have unique anatomical and physiological considerations that necessitate specialized approaches to corneal transplantation. This article will discuss the different types of corneal transplants, their indications, and outcomes in children.

Why Corneal Transplants in Children?

Corneal transplants, also known as keratoplasty, are often necessary when the cornea, the clear front surface of the eye, becomes damaged or diseased, leading to vision impairment. In children, this can be due to a variety of conditions, including:

• Keratoconus: Most common condition where pediatric corneal transplant is done
• Congenital Hereditary Endothelial Dystrophy (CHED): A genetic condition causing cloudy corneas from birth.
• Anterior segment developmental anomalies, such as Peter’s anomaly
• Congenital glaucoma: Elevated pressure inside the eye leading to corneal clouding.
• Corneal scarring from infections, trauma, or previous surgeries.

Types of Corneal Transplant Procedures

There are different types of corneal transplant procedures, each designed to address specific issues. These include:

• Penetrating Keratoplasty (PKP)

PKP is a full-thickness corneal transplant where the entire damaged cornea is replaced with a donor cornea. While historically the standard approach, PKP is associated with a higher risk of complications, such as:

• Endothelial rejection: The body’s immune system attacks the transplanted tissue.
• Infection
• Astigmatism
• Graft failure

• Lamellar Keratoplasty (LK)

LK involves replacing only the diseased layers of the cornea, leaving the healthy layers untouched. This approach is becoming increasingly popular due to its lower risk of complications compared to PKP. LK includes the following procedures:

• Superficial Anterior Lamellar Keratoplasty (SALK): Replaces the superficial layers of the cornea. It’s often used for conditions like superficial corneal scarring or dystrophies.
• Deep Anterior Lamellar Keratoplasty (DALK): Replaces the anterior and mid-layers of the cornea, preserving the patient’s own endothelium. It’s a good option for conditions affecting the stroma, such as keratoconus, and scarring.
• Descemet’s Stripping Endothelial Keratoplasty (DSEK/DSAEK): Uses a microkeratome to prepare a donor tissue that includes endothelium and a thin layer of stroma. It is commonly used for endothelial dysfunction, such as CHED.
• Descemet Membrane Endothelial Keratoplasty (DMEK): Replaces only the Descemet membrane and endothelium, without any donor stroma. It results in faster visual recovery.

Special Considerations in Pediatric Corneal Transplantation

Corneal transplant in children presents several unique challenges:

• Anesthesia: Children often require general anesthesia for surgery, which carries its own risks.
• Scleral Rigidity: Children have less rigid sclera, making surgery more challenging.
• Postoperative Care: Children need meticulous post-operative care and long-term follow-up. Follow-up can be challenging with need for repeated examinations under general anesthesia.
• Amblyopia: Children are at a high risk of developing amblyopia (lazy eye) if their vision is not clear early after the surgery, thus prompt visual rehabilitation is very important.
• Medication compliance: Children may have suboptimal compliance with medications.

Surgical Techniques

Specific techniques are used to enhance the outcomes of corneal transplants in children.

• Manual Dissection: This technique is often used in DALK for MPS corneas since these can be stiff and opaque, preventing the use of the “big bubble” technique.
• Viscodissection: Viscoelastic material is used to separate the corneal layers during DALK.

Outcomes of Corneal Transplantation in Children

Outcomes of corneal transplants depend on various factors, including the type of transplant, the underlying condition, and the child’s age.

• Visual Acuity: Significant improvement in vision is possible with successful transplants. For example, after DALK, children with MPS can achieve improved visual acuity, sometimes reaching 20/50. Similarly, children with CHED can achieve clear grafts and improved vision with DSEK.
• Graft Clarity: In DALK, most grafts remain clear over time. For example, in one study, 96% of grafts were clear at a mean follow-up of 42  months.
• Complications: Complications can include graft rejection, infection, cataract, and glaucoma. Some patients may require repeat transplants.

Importance of Corneal Transplantation

Corneal transplants can really change the course of life for children affected with corneal diseases in children and might even restore clarity, improve the quality of life by . Our corneal transplant and pediatric ophthalmology team specializes in child corneal transplant surgery and post-operative care to restore vision in young patients with corneal diseases. Delay in care for corneal disease, can potentially cause irreversible vision loss in pediatric age group. Hence, its prudent to get the right procedure done before its too late.

Recovery and Aftercare

Corneal transplant recovery in children differs in duration among the various procedures and patients, typically requiring a healing and treatment phase to prevent infection and rejection. Regular follow-up is essential to monitor the patient’s healing process and ensure corneal transplant success in kids.

Dedication to Pediatric Corneal Eye Care at Madurai Eye Center

At Madurai Eye Center, we give the best possible care for children suffering from corneal diseases in children. Our team of experienced ophthalmologists and dedicated staff remain committed to vision restoration of young patients through pediatric corneal keratoplasty and vision rehabilitation. Here, we provide total care and services ranging from surgeries like child corneal transplant procedures  to vision rehabilitation with glasses and specialty contact lenses and post-operative follow-up.

Conclusion

Corneal transplantation is life-altering, giving back eyesight in children suffering from corneal diseases. We at Madurai Eye Centre, Coimbatore, are committed to offering our best care for our young patients. If you or your child are considering eye transplant surgery in children or seeking consultation regarding pediatric corneal transplant outcomes, we would like to schedule a consultation with our experienced ophthalmologists.

Schedule an appointment at Madurai Eye Center (RS Puram & Kuniyamuthur), or call us at +91 9626613737 to know more