Pediatric Keratoplasty
Pediatric Keratoplasty
Infants and children have more rapid wound healing compared with adults. Wound healing and contraction can result in loosening of the sutures followed by suture erosion. The irritation from the loose sutures can, in turn, lead to eye rubbing, stimulation of vascularization and increased risk of infectious keratitis, placing the transplanted cornea in danger of graft rejection and failure. Accordingly, the sutures should be removed before erosion and subsequent complications occur. During postoperative examinations performed under anesthesia, the graft sutures should be inspected carefully and individual sutures that are loose or inciting neovascularization should be removed. In children under the age of 5 years, often all of the sutures need to be removed within 1-3 months of surgery because of rapid wound healing, which occurs particularly in infants. In children over the age of 5 years, after 6 months, the remaining sutures can be removed or selectively removed to reduce astigmatism as in adults. Some surgeons, on the other hand, advocate removing all of the sutures at a certain time, with the postoperative period lengthening with increasing age of the child but occurring as early as 4-6 weeks after surgery in young infants.
Infants and children have more rapid wound healing compared with adults. Wound healing and contraction can result in loosening of the sutures followed by suture erosion. The irritation from the loose sutures can, in turn, lead to eye rubbing, stimulation of vascularization and increased risk of infectious keratitis, placing the transplanted cornea in danger of graft rejection and failure. Accordingly, the sutures should be removed before erosion and subsequent complications occur. During postoperative examinations performed under anesthesia, the graft sutures should be inspected carefully and individual sutures that are loose or inciting neovascularization should be removed. In children under the age of 5 years, often all of the sutures need to be removed within 1-3 months of surgery because of rapid wound healing, which occurs particularly in infants. In children over the age of 5 years, after 6 months, the remaining sutures can be removed or selectively removed to reduce astigmatism as in adults. Some surgeons, on the other hand, advocate removing all of the sutures at a certain time, with the postoperative period lengthening with increasing age of the child but occurring as early as 4-6 weeks after surgery in young infants.
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