G. Avgitidou

Aktuelle Aspekte zur Lid-, Tränenwegs- und Orbitachirurgie im Kindesalter

ZusammenfassungHintergrundLid-, Tränenwegs- und Orbitaerkrankungen im Kindesalter unterscheiden sich in ihrem Spektrum und der notwendigen therapeutischen Versorgung von denen im Erwachsenenalter.FragestellungEs soll ein Überblick über die Klinik und Therapie der häufigsten kindlichen Lid-, Tränenwegs- und Orbitaerkrankungen gegeben werden.MethodenDer Beitrag bietet eine Literaturübersicht aus PUBMED und eigene klinische Ergebnisse.ErgebnisseZu den häufigsten Liderkrankungen des Kindesalters zählen kongenitale Lidfehlstellungen wie Ptosis oder Entropium, die bei Gefahr der Amblyopie eine chirurgische Korrektur benötigen. Bei der konnatalen Tränenwegsstenose sollte eine Stufentherapie erfolgen: 1) konservativ mit Tränensackmassage, adstringierenden Augen- und Nasentropfen, 2) Tränenwegsspülung und 3) Tränenwegsspülung und -schienung in Narkose. Benigne Orbitaprozesse wie Dermoidzysten sind gut im Vorschulalter anzugehen. Die systemische β-Blocker-Therapie stellt eine neue konservative Behandlungsoption für kapilläre Hämangiome dar, die bei Fehlen von Kontraindikationen anstelle operativer Maßnahmen primär indiziert werden sollte.SchlussfolgerungenBei Amblyopiegefahr bedürfen Lid- und Orbitaerkrankungen im Kindesalter der raschen, in der Regel operativen Versorgung. Bei konnatalen Tränenwegsstenosen wie auch kapillären Hämangiomen ist ein initial konservatives Vorgehen indiziert.AbstractBackgroundDuring childhood the spectrum of disorders of the eyelid, the lacrimal drainage system and the orbit as well as the subsequent therapeutic management differ from those in adults.ObjectivesThis review outlines the clinical picture and treatment of the most common eyelid, lacrimal drainage and orbital diseases in childhood.MethodsThe study comprises a PubMed literature review and own clinical results.ResultsThe most common eyelid disorders in childhood include congenital malpositions, such as ptosis or entropium, which may require fast surgical correction in order to prevent amblyopia. For connatal dacryostenosis a step-by-step therapeutic approach is recommended: (1) conservative treatment using lacrimal sac massage, astringent eye and nose drops, (2) irrigation and probing of the nasolacrimal system and (3) irrigation, probing and silastic tube intubation under general anesthesia. Benign orbital lesions such as dermoid cysts can be removed at pre-school age. Using systemic beta blockers is a novel conservative approach in the treatment of capillary hemangioma, which should precede surgical interventions.ConclusionEyelid and orbital diseases during childhood may require fast surgical intervention to prevent amblyopia. Initial conservative treatment is recommended for connatal dacryostenosis and capillary hemangioma.BACKGROUND During childhood the spectrum of disorders of the eyelid, the lacrimal drainage system and the orbit as well as the subsequent therapeutic management differ from those in adults. OBJECTIVES This review outlines the clinical picture and treatment of the most common eyelid, lacrimal drainage and orbital diseases in childhood. METHODS The study comprises a PubMed literature review and own clinical results. RESULTS The most common eyelid disorders in childhood include congenital malpositions, such as ptosis or entropium, which may require fast surgical correction in order to prevent amblyopia. For connatal dacryostenosis a step-by-step therapeutic approach is recommended: (1) conservative treatment using lacrimal sac massage, astringent eye and nose drops, (2) irrigation and probing of the nasolacrimal system and (3) irrigation, probing and silastic tube intubation under general anesthesia. Benign orbital lesions such as dermoid cysts can be removed at pre-school age. Using systemic beta blockers is a novel conservative approach in the treatment of capillary hemangioma, which should precede surgical interventions. CONCLUSION Eyelid and orbital diseases during childhood may require fast surgical intervention to prevent amblyopia. Initial conservative treatment is recommended for connatal dacryostenosis and capillary hemangioma.

Pediatric corneal surgery and corneal transplantation

ZusammenfassungDie operative Therapie kindlicher Hornhauterkrankungen stellt auch für den erfahrenen Hornhautchirurgen eine Sondersituation dar. Neben der generell erschwerten Befunderhebung bei Kindern sind die Hornhaut und die angrenzende Sklera bei Säuglingen und Kleinkindern noch sehr weich, wodurch beispielsweise bei Keratoplastik die wunddichte Nahtlegung erschwert ist. Intraoperativ sorgen die flache Augenvorderkammer im kleinen kindlichen Auge und der typischerweise recht hohe Glaskörperdruck für enge Platzverhältnisse und wenig Spielraum für chirurgische Manipulationen. Frühe Fadenlockerungen, ein erhöhtes Risiko von postoperativen Fibrinreaktionen sowie immunologischen Transplantatreaktionen nach Keratoplastik und die drohende Amblyopiegefahr machen intensive Kontrollen, teilweise unter Narkose, notwendig. Gerade bei den sehr kleinen Patienten bieten lamelläre chirurgische Verfahren wesentliche Vorteile, da hierdurch die Gefahr von Abstoßungsreaktionen reduziert und durch die geringere Invasivität des Eingriffs bei anterioren lamellären Techniken keine bzw. nur eine geringe Eröffnung der Augenvorderkammer erfolgt. Die schnellere Herstellung optisch klarer Medien bei posterioren lamellären Techniken reduziert darüber hinaus die Amblyopiegefahr.AbstractThe surgical treatment of congenital corneal diseases or corneal diseases occurring during infancy is demanding even for experienced corneal surgeons. Besides the need for frequent examinations under anesthesia during the postoperative follow-up in young children and infants (e.g. after corneal transplantation), the surgeon frequently encounters intraoperative and postoperative problems, such as low scleral rigidity, positive vitreous pressure and a narrow anterior chamber. Other problems include increased fibrin reaction, an increased risk of rejection in cases of allogenic corneal transplantation and frequent loosening of sutures necessitating replacement or early removal. Lamellar corneal transplantation reduces the risk of graft rejection and the risk of wound leakage. Moreover, posterior lamellar keratoplasty in children offers a faster visual recovery compared to penetrating keratoplasty and thus reduces the risk of amblyopia.The surgical treatment of congenital corneal diseases or corneal diseases occurring during infancy is demanding even for experienced corneal surgeons. Besides the need for frequent examinations under anesthesia during the postoperative follow-up in young children and infants (e.g. after corneal transplantation), the surgeon frequently encounters intraoperative and postoperative problems, such as low scleral rigidity, positive vitreous pressure and a narrow anterior chamber. Other problems include increased fibrin reaction, an increased risk of rejection in cases of allogenic corneal transplantation and frequent loosening of sutures necessitating replacement or early removal. Lamellar corneal transplantation reduces the risk of graft rejection and the risk of wound leakage. Moreover, posterior lamellar keratoplasty in children offers a faster visual recovery compared to penetrating keratoplasty and thus reduces the risk of amblyopia.

Eyelid aging: pathophysiology and clinical management

Life expectancy is increasing in most countries. With increasing age, many individuals may develop involutional ophthalmic diseases, such as eyelid aging. Dermatochalasis, ptosis, ectropion, and entropion are common disorders in middle-aged and older adults. This review outlines the pathophysiology and clinical management of these involutional eyelid disorders. Recently, a decrease in elastic fibers with ultrastructural abnormalities and an overexpression of elastin-degrading enzymes have been demonstrated in involutional ectropion and entropion. This may be the consequence of local ischemia, inflammation, and/or chronic mechanical stress. Eyelid aging with progressive loss of tone and laxity may affect the ocular surface and adnexal tissues, resulting in different clinical symptoms and signs. Surgical management depends on the appropriate correction of the underlying anatomical defect.

[Current aspects of eyelid, lacrimal and orbital surgery in childhood].

ZusammenfassungHintergrundLid-, Tränenwegs- und Orbitaerkrankungen im Kindesalter unterscheiden sich in ihrem Spektrum und der notwendigen therapeutischen Versorgung von denen im Erwachsenenalter.FragestellungEs soll ein Überblick über die Klinik und Therapie der häufigsten kindlichen Lid-, Tränenwegs- und Orbitaerkrankungen gegeben werden.MethodenDer Beitrag bietet eine Literaturübersicht aus PUBMED und eigene klinische Ergebnisse.ErgebnisseZu den häufigsten Liderkrankungen des Kindesalters zählen kongenitale Lidfehlstellungen wie Ptosis oder Entropium, die bei Gefahr der Amblyopie eine chirurgische Korrektur benötigen. Bei der konnatalen Tränenwegsstenose sollte eine Stufentherapie erfolgen: 1) konservativ mit Tränensackmassage, adstringierenden Augen- und Nasentropfen, 2) Tränenwegsspülung und 3) Tränenwegsspülung und -schienung in Narkose. Benigne Orbitaprozesse wie Dermoidzysten sind gut im Vorschulalter anzugehen. Die systemische β-Blocker-Therapie stellt eine neue konservative Behandlungsoption für kapilläre Hämangiome dar, die bei Fehlen von Kontraindikationen anstelle operativer Maßnahmen primär indiziert werden sollte.SchlussfolgerungenBei Amblyopiegefahr bedürfen Lid- und Orbitaerkrankungen im Kindesalter der raschen, in der Regel operativen Versorgung. Bei konnatalen Tränenwegsstenosen wie auch kapillären Hämangiomen ist ein initial konservatives Vorgehen indiziert.AbstractBackgroundDuring childhood the spectrum of disorders of the eyelid, the lacrimal drainage system and the orbit as well as the subsequent therapeutic management differ from those in adults.ObjectivesThis review outlines the clinical picture and treatment of the most common eyelid, lacrimal drainage and orbital diseases in childhood.MethodsThe study comprises a PubMed literature review and own clinical results.ResultsThe most common eyelid disorders in childhood include congenital malpositions, such as ptosis or entropium, which may require fast surgical correction in order to prevent amblyopia. For connatal dacryostenosis a step-by-step therapeutic approach is recommended: (1) conservative treatment using lacrimal sac massage, astringent eye and nose drops, (2) irrigation and probing of the nasolacrimal system and (3) irrigation, probing and silastic tube intubation under general anesthesia. Benign orbital lesions such as dermoid cysts can be removed at pre-school age. Using systemic beta blockers is a novel conservative approach in the treatment of capillary hemangioma, which should precede surgical interventions.ConclusionEyelid and orbital diseases during childhood may require fast surgical intervention to prevent amblyopia. Initial conservative treatment is recommended for connatal dacryostenosis and capillary hemangioma.BACKGROUND During childhood the spectrum of disorders of the eyelid, the lacrimal drainage system and the orbit as well as the subsequent therapeutic management differ from those in adults. OBJECTIVES This review outlines the clinical picture and treatment of the most common eyelid, lacrimal drainage and orbital diseases in childhood. METHODS The study comprises a PubMed literature review and own clinical results. RESULTS The most common eyelid disorders in childhood include congenital malpositions, such as ptosis or entropium, which may require fast surgical correction in order to prevent amblyopia. For connatal dacryostenosis a step-by-step therapeutic approach is recommended: (1) conservative treatment using lacrimal sac massage, astringent eye and nose drops, (2) irrigation and probing of the nasolacrimal system and (3) irrigation, probing and silastic tube intubation under general anesthesia. Benign orbital lesions such as dermoid cysts can be removed at pre-school age. Using systemic beta blockers is a novel conservative approach in the treatment of capillary hemangioma, which should precede surgical interventions. CONCLUSION Eyelid and orbital diseases during childhood may require fast surgical intervention to prevent amblyopia. Initial conservative treatment is recommended for connatal dacryostenosis and capillary hemangioma.

Hornhautchirurgie und Hornhauttransplantation bei Kindern

ZusammenfassungDie operative Therapie kindlicher Hornhauterkrankungen stellt auch für den erfahrenen Hornhautchirurgen eine Sondersituation dar. Neben der generell erschwerten Befunderhebung bei Kindern sind die Hornhaut und die angrenzende Sklera bei Säuglingen und Kleinkindern noch sehr weich, wodurch beispielsweise bei Keratoplastik die wunddichte Nahtlegung erschwert ist. Intraoperativ sorgen die flache Augenvorderkammer im kleinen kindlichen Auge und der typischerweise recht hohe Glaskörperdruck für enge Platzverhältnisse und wenig Spielraum für chirurgische Manipulationen. Frühe Fadenlockerungen, ein erhöhtes Risiko von postoperativen Fibrinreaktionen sowie immunologischen Transplantatreaktionen nach Keratoplastik und die drohende Amblyopiegefahr machen intensive Kontrollen, teilweise unter Narkose, notwendig. Gerade bei den sehr kleinen Patienten bieten lamelläre chirurgische Verfahren wesentliche Vorteile, da hierdurch die Gefahr von Abstoßungsreaktionen reduziert und durch die geringere Invasivität des Eingriffs bei anterioren lamellären Techniken keine bzw. nur eine geringe Eröffnung der Augenvorderkammer erfolgt. Die schnellere Herstellung optisch klarer Medien bei posterioren lamellären Techniken reduziert darüber hinaus die Amblyopiegefahr.AbstractThe surgical treatment of congenital corneal diseases or corneal diseases occurring during infancy is demanding even for experienced corneal surgeons. Besides the need for frequent examinations under anesthesia during the postoperative follow-up in young children and infants (e.g. after corneal transplantation), the surgeon frequently encounters intraoperative and postoperative problems, such as low scleral rigidity, positive vitreous pressure and a narrow anterior chamber. Other problems include increased fibrin reaction, an increased risk of rejection in cases of allogenic corneal transplantation and frequent loosening of sutures necessitating replacement or early removal. Lamellar corneal transplantation reduces the risk of graft rejection and the risk of wound leakage. Moreover, posterior lamellar keratoplasty in children offers a faster visual recovery compared to penetrating keratoplasty and thus reduces the risk of amblyopia.The surgical treatment of congenital corneal diseases or corneal diseases occurring during infancy is demanding even for experienced corneal surgeons. Besides the need for frequent examinations under anesthesia during the postoperative follow-up in young children and infants (e.g. after corneal transplantation), the surgeon frequently encounters intraoperative and postoperative problems, such as low scleral rigidity, positive vitreous pressure and a narrow anterior chamber. Other problems include increased fibrin reaction, an increased risk of rejection in cases of allogenic corneal transplantation and frequent loosening of sutures necessitating replacement or early removal. Lamellar corneal transplantation reduces the risk of graft rejection and the risk of wound leakage. Moreover, posterior lamellar keratoplasty in children offers a faster visual recovery compared to penetrating keratoplasty and thus reduces the risk of amblyopia.

Brittle Cornea Syndrome: Case Report with Novel Mutation in the PRDM5 Gene and Review of the Literature

A 3-year-old boy presented with acute corneal hydrops on the left eye and spontaneous corneal rupture on the right eye. A diagnosis of brittle cornea syndrome was confirmed by molecular analysis. A novel mutation, the homozygous variant c.17T>G, p.V6G, was found in the gene for PR-domain-containing protein 5 (PRDM5) in exon 1. Brittle cornea syndrome is a rare connective tissue disease with typical ocular, auditory, musculoskeletal, and cutaneous disorders. Almost all patients suffer from declined vision due to corneal scarring, thinning, and rupture. The most common ophthalmologic findings include keratoconus, progressive central corneal thinning, high myopia, irregular astigmatism, retinal detachment, and high risk for spontaneous corneal or scleral rupture. In addition to describing the case with a novel mutation here we review the current literature on brittle cornea syndrome pathogenesis, clinical findings, and therapy.

Ophthalmologische Manifestationen des Cornelia-de-Lange-Syndroms

A 2-year-old boy suffering from Cornelia de Lange syndrome, presented with mucopurulent ocular discharge and epiphora since birth. Irrigation and probing of the nasolacrimal system revealed and successfully treated bilateral nasolacrimal duct obstructions. Cornelia de Lange syndrome is characterized not only by typical facial features, visceral and urogenital anomalies but also by ophthalmological manifestations in 99% of cases. The most common ophthalmological disorders are synophrys, blepharitis, epiphora, hypertrichosis of the eyebrows and eyelashes, myopia, ptosis and nasolacrimal duct obstruction.ZusammenfassungDie Eltern eines 2-jährigen Jungen mit Cornelia-de-Lange-Syndrom berichteten von mukopurulenter Tränensekretion und Epiphora seit Geburt. Die Tränenwegsspülung mittels Bangerter-Überdruckspülung offenbarte eine beidseitige konnatale Tränenwegsstenose, die dadurch erfolgreich behandelt wurde. Beim Cornelia-de-Lange-Syndrom liegen neben dysmorphen Gesichtszügen und Fehlbildungen der Organsysteme zu 99 % auch okuläre Auffälligkeiten vor. So prägen Synophrys, Blepharitis, Epiphora, Hypertrichose der Augenbrauen, Myopie, Ptosis, lange Wimpern und nasolakrimale Fehlbildungen das klinische Bild.AbstractA 2-year-old boy suffering from Cornelia de Lange syndrome, presented with mucopurulent ocular discharge and epiphora since birth. Irrigation and probing of the nasolacrimal system revealed and successfully treated bilateral nasolacrimal duct obstructions. Cornelia de Lange syndrome is characterized not only by typical facial features, visceral and urogenital anomalies but also by ophthalmological manifestations in 99 % of cases. The most common ophthalmological disorders are synophrys, blepharitis, epiphora, hypertrichosis of the eyebrows and eyelashes, myopia, ptosis and nasolacrimal duct obstruction.

[Ophthalmological manifestations of Cornelia de Lange syndrome: Case report and review of the literature].

A 2-year-old boy suffering from Cornelia de Lange syndrome, presented with mucopurulent ocular discharge and epiphora since birth. Irrigation and probing of the nasolacrimal system revealed and successfully treated bilateral nasolacrimal duct obstructions. Cornelia de Lange syndrome is characterized not only by typical facial features, visceral and urogenital anomalies but also by ophthalmological manifestations in 99% of cases. The most common ophthalmological disorders are synophrys, blepharitis, epiphora, hypertrichosis of the eyebrows and eyelashes, myopia, ptosis and nasolacrimal duct obstruction.ZusammenfassungDie Eltern eines 2-jährigen Jungen mit Cornelia-de-Lange-Syndrom berichteten von mukopurulenter Tränensekretion und Epiphora seit Geburt. Die Tränenwegsspülung mittels Bangerter-Überdruckspülung offenbarte eine beidseitige konnatale Tränenwegsstenose, die dadurch erfolgreich behandelt wurde. Beim Cornelia-de-Lange-Syndrom liegen neben dysmorphen Gesichtszügen und Fehlbildungen der Organsysteme zu 99 % auch okuläre Auffälligkeiten vor. So prägen Synophrys, Blepharitis, Epiphora, Hypertrichose der Augenbrauen, Myopie, Ptosis, lange Wimpern und nasolakrimale Fehlbildungen das klinische Bild.AbstractA 2-year-old boy suffering from Cornelia de Lange syndrome, presented with mucopurulent ocular discharge and epiphora since birth. Irrigation and probing of the nasolacrimal system revealed and successfully treated bilateral nasolacrimal duct obstructions. Cornelia de Lange syndrome is characterized not only by typical facial features, visceral and urogenital anomalies but also by ophthalmological manifestations in 99 % of cases. The most common ophthalmological disorders are synophrys, blepharitis, epiphora, hypertrichosis of the eyebrows and eyelashes, myopia, ptosis and nasolacrimal duct obstruction.

Aktuelle Aspekte zur Lid-, Tränenwegs- und Orbitachirurgie im Kindesalter@@@Current aspects of eyelid, lacrimal and orbital surgery in childhood

ZusammenfassungHintergrundLid-, Tränenwegs- und Orbitaerkrankungen im Kindesalter unterscheiden sich in ihrem Spektrum und der notwendigen therapeutischen Versorgung von denen im Erwachsenenalter.FragestellungEs soll ein Überblick über die Klinik und Therapie der häufigsten kindlichen Lid-, Tränenwegs- und Orbitaerkrankungen gegeben werden.MethodenDer Beitrag bietet eine Literaturübersicht aus PUBMED und eigene klinische Ergebnisse.ErgebnisseZu den häufigsten Liderkrankungen des Kindesalters zählen kongenitale Lidfehlstellungen wie Ptosis oder Entropium, die bei Gefahr der Amblyopie eine chirurgische Korrektur benötigen. Bei der konnatalen Tränenwegsstenose sollte eine Stufentherapie erfolgen: 1) konservativ mit Tränensackmassage, adstringierenden Augen- und Nasentropfen, 2) Tränenwegsspülung und 3) Tränenwegsspülung und -schienung in Narkose. Benigne Orbitaprozesse wie Dermoidzysten sind gut im Vorschulalter anzugehen. Die systemische β-Blocker-Therapie stellt eine neue konservative Behandlungsoption für kapilläre Hämangiome dar, die bei Fehlen von Kontraindikationen anstelle operativer Maßnahmen primär indiziert werden sollte.SchlussfolgerungenBei Amblyopiegefahr bedürfen Lid- und Orbitaerkrankungen im Kindesalter der raschen, in der Regel operativen Versorgung. Bei konnatalen Tränenwegsstenosen wie auch kapillären Hämangiomen ist ein initial konservatives Vorgehen indiziert.AbstractBackgroundDuring childhood the spectrum of disorders of the eyelid, the lacrimal drainage system and the orbit as well as the subsequent therapeutic management differ from those in adults.ObjectivesThis review outlines the clinical picture and treatment of the most common eyelid, lacrimal drainage and orbital diseases in childhood.MethodsThe study comprises a PubMed literature review and own clinical results.ResultsThe most common eyelid disorders in childhood include congenital malpositions, such as ptosis or entropium, which may require fast surgical correction in order to prevent amblyopia. For connatal dacryostenosis a step-by-step therapeutic approach is recommended: (1) conservative treatment using lacrimal sac massage, astringent eye and nose drops, (2) irrigation and probing of the nasolacrimal system and (3) irrigation, probing and silastic tube intubation under general anesthesia. Benign orbital lesions such as dermoid cysts can be removed at pre-school age. Using systemic beta blockers is a novel conservative approach in the treatment of capillary hemangioma, which should precede surgical interventions.ConclusionEyelid and orbital diseases during childhood may require fast surgical intervention to prevent amblyopia. Initial conservative treatment is recommended for connatal dacryostenosis and capillary hemangioma.BACKGROUND During childhood the spectrum of disorders of the eyelid, the lacrimal drainage system and the orbit as well as the subsequent therapeutic management differ from those in adults. OBJECTIVES This review outlines the clinical picture and treatment of the most common eyelid, lacrimal drainage and orbital diseases in childhood. METHODS The study comprises a PubMed literature review and own clinical results. RESULTS The most common eyelid disorders in childhood include congenital malpositions, such as ptosis or entropium, which may require fast surgical correction in order to prevent amblyopia. For connatal dacryostenosis a step-by-step therapeutic approach is recommended: (1) conservative treatment using lacrimal sac massage, astringent eye and nose drops, (2) irrigation and probing of the nasolacrimal system and (3) irrigation, probing and silastic tube intubation under general anesthesia. Benign orbital lesions such as dermoid cysts can be removed at pre-school age. Using systemic beta blockers is a novel conservative approach in the treatment of capillary hemangioma, which should precede surgical interventions. CONCLUSION Eyelid and orbital diseases during childhood may require fast surgical intervention to prevent amblyopia. Initial conservative treatment is recommended for connatal dacryostenosis and capillary hemangioma.

Hornhautchirurgie und Hornhauttransplantation bei Kindern@@@Pediatric corneal surgery and corneal transplantation

ZusammenfassungDie operative Therapie kindlicher Hornhauterkrankungen stellt auch für den erfahrenen Hornhautchirurgen eine Sondersituation dar. Neben der generell erschwerten Befunderhebung bei Kindern sind die Hornhaut und die angrenzende Sklera bei Säuglingen und Kleinkindern noch sehr weich, wodurch beispielsweise bei Keratoplastik die wunddichte Nahtlegung erschwert ist. Intraoperativ sorgen die flache Augenvorderkammer im kleinen kindlichen Auge und der typischerweise recht hohe Glaskörperdruck für enge Platzverhältnisse und wenig Spielraum für chirurgische Manipulationen. Frühe Fadenlockerungen, ein erhöhtes Risiko von postoperativen Fibrinreaktionen sowie immunologischen Transplantatreaktionen nach Keratoplastik und die drohende Amblyopiegefahr machen intensive Kontrollen, teilweise unter Narkose, notwendig. Gerade bei den sehr kleinen Patienten bieten lamelläre chirurgische Verfahren wesentliche Vorteile, da hierdurch die Gefahr von Abstoßungsreaktionen reduziert und durch die geringere Invasivität des Eingriffs bei anterioren lamellären Techniken keine bzw. nur eine geringe Eröffnung der Augenvorderkammer erfolgt. Die schnellere Herstellung optisch klarer Medien bei posterioren lamellären Techniken reduziert darüber hinaus die Amblyopiegefahr.AbstractThe surgical treatment of congenital corneal diseases or corneal diseases occurring during infancy is demanding even for experienced corneal surgeons. Besides the need for frequent examinations under anesthesia during the postoperative follow-up in young children and infants (e.g. after corneal transplantation), the surgeon frequently encounters intraoperative and postoperative problems, such as low scleral rigidity, positive vitreous pressure and a narrow anterior chamber. Other problems include increased fibrin reaction, an increased risk of rejection in cases of allogenic corneal transplantation and frequent loosening of sutures necessitating replacement or early removal. Lamellar corneal transplantation reduces the risk of graft rejection and the risk of wound leakage. Moreover, posterior lamellar keratoplasty in children offers a faster visual recovery compared to penetrating keratoplasty and thus reduces the risk of amblyopia.The surgical treatment of congenital corneal diseases or corneal diseases occurring during infancy is demanding even for experienced corneal surgeons. Besides the need for frequent examinations under anesthesia during the postoperative follow-up in young children and infants (e.g. after corneal transplantation), the surgeon frequently encounters intraoperative and postoperative problems, such as low scleral rigidity, positive vitreous pressure and a narrow anterior chamber. Other problems include increased fibrin reaction, an increased risk of rejection in cases of allogenic corneal transplantation and frequent loosening of sutures necessitating replacement or early removal. Lamellar corneal transplantation reduces the risk of graft rejection and the risk of wound leakage. Moreover, posterior lamellar keratoplasty in children offers a faster visual recovery compared to penetrating keratoplasty and thus reduces the risk of amblyopia.