Clinical Analysis Of Pediatric Keratoplasty

Children's nerve centre , especially vision cortex is in developing segment . Without enough stimulation of light to retina between early time after birth , it will lead to nonreversible amblyopia . Nubecula is one of the main causes to amblyopia , thus pediatric keratoplasty has great significance to the recover of visual function of these children . Because of the speciality in anatomy and physiology of children's eyeball , it makes it rather more difficult to operate in children than in adult . Both inside and outside the nation , dissertations on pediatric keratoplasty , especially on lameller keratoplasty , is rare . This study picked 59 children ( 60 eyes ) randomly performed with pediatic keratoplasty from may 1985 to march 2004 in our hospital . Summarize and analyze various factors correlative with the rate of graft transparency and the rate of rejection . Information : This group includes 59 children ( 60eyes ) between 4 and 14 years old . Penetrating keratoplasty was performed on 40 eyes while lameller keratoplasty was performed on 20 eyes . Most of offering corneas are fresh . Postoperative follow up was 1m~7.6y . Before being performed with penetrating keratoplasty , 5 eyes are congenital nubecula , 32 eyes are simple nubecula , 1 eye is active keratitis , 2 eyes are thermalchemical injury . 8 eyes were performed with other operation methods at one time . While in the case of lameller keratoplasty , 12 eyes are congenital nubecula , 1 eye is simple nubecula , 6 eyes are thermalchemical injury, 1 eye's nubecula is caused after taking sulfanilamide medicine . 1 eye is the second time under operation . 26 children are performed under local anaesthesia , all the others are under general anesthesia with partial local anaesthesia . After anaesthesia , oppressing the eyeball a little longer to make it intenerated enough . No matter iris has adherence or not , miosis is necessary before operation . The operation is performed under microscope . The size of the bed is according to the range of cornea pathological changes , the slice is 0.2～0.5ｍｍ bigger than the bed . Continuously suture . While in lameller keratoplasty , the size of the slice and the bed is the same . Interuptedly suture . Bind up with bandage . Both in system and in local postoperatively , antibiotics and dexamethasone is used . Add 1% cyclosporine A drops . The time of bandage and stitches is shorter than adult . Coutercheck periodically after leaving hospital , callback at the time of changing , exercise amblyopia . Results : The total rate of graft transparency was 70% . In penetrating keratoplasty , the rate of graft transparency was 75% , the rate of vision improvement is 72.5% , 59.26% patients were no longer blind , and 27.27% got rid of deformity , the rate of immune rejection was 22.5% . While in lameller Keratoplasty , the rate of graft transparency was 65% , the rate of vision improvement is 35% , 10% patients were no longer blind , the rate of immune rejection was 45% .Among these cases , 8 eyes are nubecula caused by thermalchemistry injury among which 6 eyes have immune rejection postoperatively . 1 eye is perforation caused by active keratitis which has immune rejection after penetrating keratoplasty . 7 eyes were performed partial center graft among which 2 eyes have immune rejection postoperatively. 2 eyes were performed keratoplasty the sencond time among which 1 eye has immun rejection postoperatively. 8 eyes were performed penetrating keratoplasty conbined with other operation methods among which 2 eyes have immune rejection postoperatively. Preoperatively 13 eyes have new vesculargenisis on cornea above "+++" among which 9 eyes have immune rejection. 14 eyes graft diametre are above 8mm among which 7 eyes have immune rejection.Complications : Postoperatively ,secondary glaucoma is occured in 5 eyes ,complicated cataract is occurred in 2 eyes ,1 eye's iris gets out from the cut ,1 eye suffers from lilamentary keratitis .Discussion :1.The age of the children wh...