2020–2021 BCSC Basic and Clinical Science Course™
6 Pediatric Ophthalmology and Strabismus
Part II: Pediatric Ophthalmology
Chapter 21: Disorders of the Anterior Segment
Abnormalities of Central and Diffuse Corneal Transparency
Treatment of Corneal Opacities
If bilateral dense opacities are present, early keratoplasty can be considered for 1 eye so that deprivation amblyopia can be minimized. Coexistent anterior segment disease must be considered before keratoplasty is undertaken. If the opacity is unilateral, the decision is more difficult. Keratoplasty should be undertaken only if the family and the ophthalmologists involved in the child’s care are prepared for the significant commitment of time and effort needed to deal with corneal graft rejection, which occurs often in children, as well as with amblyopia. The team should include ophthalmologists skilled in pediatric corneal surgery, pediatric glaucoma, and amblyopia. Contact lens expertise is important for the care of infants with small eyes and large refractive errors. Repeated examinations under anesthesia are often required.
Figure 21-11 Descemet tears following minor trauma in a child with brittle cornea syndrome.
(Courtesy of Arif O. Khan, MD.)
In addition to traditional penetrating keratoplasty, treatment options include optical iridectomy, deep anterior lamellar keratoplasty (DALK; used for stromal disease with healthy endothelium), DSEK (used to replace diseased endothelium or Descemet membrane), and keratoprostheses.
Ashar JN, Ramappa M, Vaddavalli PK. Paired-eye comparison of Descemet’s stripping endothelial keratoplasty and penetrating keratoplasty in children with congenital hereditary endothelial dystrophy. Br J Ophthalmol. 2013;97(10):1247–1249.
Harding SA, Nischal KK, Upponi-Patil A, Fowler DJ. Indications and outcomes of deep anterior lamellar keratoplasty in children. Ophthalmology. 2010;117(11):2191–2195.
Excerpted from BCSC 2020-2021 series: Section 10 - Glaucoma. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.