Abstract：
Managing pediatric corneal disorders is challenging as the prognosis of pediatric keratoplasty depends on several factors. Advancements in the genetic basis of congenital corneal diseases and investigations in congenital corneal conditions provide a better understanding of pediatric corneal conditions. Surgeons performing keratoplasty in children now have a choice of various techniques. Evolving surgical techniques of anterior lamellar and endothelial keratoplasties have expanded the management interventions in these pediatric corneal morbidity conditions; however, considerable concerns still exist in association with corneal transplantation in infants and children. Outcomes in pediatric keratoplasty depend upon the preoperative indications, the timing of surgical intervention, intraoperative and postoperative factors including the patient/care givers\' compliance. Factors such as low scleral rigidity, higher rate of graft failure, need for frequent examinations under anesthesia, and difficulty in optimal visual acuity assessment still remain a considerable challenge in pediatric scenarios. In children, deprivation amblyopia as a result of the corneal opacification can adversely affect visual development, causing dense amblyopia. Outcomes to surgical interventions for management of corneal opacification in children are further compromised by the preexisting amblyopia apart from the concerns of refractive outcome of the graft. Graft rejection, graft infection, amblyopia, and glaucoma continue to be serious concerns. In recent years both anterior and posterior lamellar keratoplasty techniques are being increasingly performed in pediatric eyes, which offer advantages in the form of lower risk of graft rejection. The timing of surgery, careful case selection, cautious intraoperative approach, and optimal postoperative management can improve the anatomical and functional outcome in difficult cases.
摘要：
由于小儿角膜移植术的预后取决于几个因素，因此管理小儿角膜疾病具有挑战性。先天性角膜疾病的遗传基础的进步和先天性角膜疾病的研究提供了对小儿角膜疾病的更好理解。现在，在儿童中进行角膜移植术的外科医生可以选择各种技术。不断发展的前板层和内皮角膜移植术的外科技术扩大了这些小儿角膜疾病的管理干预措施；然而，婴儿和儿童角膜移植仍存在相当大的问题.小儿角膜移植术的结果取决于术前适应症，手术干预的时机，术中和术后因素，包括患者/护理人员的依从性。如巩膜硬度低，移植物失败率较高，在麻醉下需要频繁的检查，在儿科情况下，难以进行最佳视力评估仍然是一个相当大的挑战。在儿童中，由于角膜混浊而导致的剥夺性弱视会对视觉发育产生不利影响，导致密集的弱视。除了对移植物屈光结局的担忧外，先前存在的弱视进一步损害了用于治疗儿童角膜混浊的手术干预措施的结果。移植物排斥,移植物感染,弱视,和青光眼仍然是严重的问题。近年来，前板层和后板层角膜移植术技术越来越多地在小儿眼睛中进行，它以较低的移植物排斥反应风险提供了优势。手术的时机,仔细选择案例，术中谨慎的方法，在困难病例中，最佳的术后管理可以改善解剖和功能结果。
