International Ophthalmology Clinics | 2021
Recent Advances in Pediatric Endothelial Keratoplasty
Abstract
Indications for pediatric keratoplasty vary worldwide. Congenital corneal opacities, for example, Peters anomaly and nontraumatic acquired ectasias like keratoconus are the most common indications in developed countries,1 while infections, trauma, and nutritional deficiencies are the leading indications in developing countries.2 There has been a significant shift in the choice of surgical technique for adult keratoplasty over the past decade, with endothelial keratoplasty (EK) now being the most commonly performed type of keratoplasty worldwide, rather than penetrating keratoplasty (PK).3 Better postoperative structural integrity, no suture related complications, less astigmatism, less follow-up visits, and lower risk of immunological graft rejection4 are factors in favor of EK. In contrast, the adoption of EK for pediatric patients, which was first described in 2008,5 has been much slower. Data from our yearly audit in Singapore over the past 11 years are shown in Figure 1. It was observed that, pediatric corneal transplants accounted for ∼5.78% of the total transplants performed over this period. Figures 2A and B shows the distributions of the various types of keratoplasty in adult and pediatric populations, respectively. Although lamellar keratoplasty accounted for ∼87% (60% EK) of cases in adults, in the pediatric population it is ∼48% (9% EK).