A Case Report of Congenital Corneal Opacity: Challenges of Keratoplasty Surgery in Children
Case Report
DOI:
https://doi.org/10.55175/cdk.v52i11.1712Keywords:
Anterior segment dysgenesis, case report, congenital corneal opacity, corneal graft, keratoplastyAbstract
Introduction: Congenital corneal opacity (CCO) is a group of anterior segment dysgenesis of the eye manifested by corneal transparency loss at birth or during the first 4 weeks of life. CCO is one of the most prominent disease entities in anterior segment dysgenesis. CCO resulted from disruptions in mesodermal development, particularly affecting the anterior segment of the eye. Case:
A 2-week-old boy with bilateral CCO. One week post-keratoplasty surgery, the parents reported no complaints but had difficulty administering eye drops. Physical examination showed a clearer corneal graft. One month later, a cloudy graft and broken sutures were noted, indicating graft rejection. The family was educated on the importance of consistent medication for any future graft surgery. Discussion: The surgical option for CCO is corneal graft or keratoplasty. Keratoplasty is a corneal transplant where a clear donor graft replaces the central opaque cornea. Conclusion: A comprehensive workup is essential for diagnosing CCO. Keratoplasty can restore corneal clarity and vision, but pediatric cases require careful patient education and comprehensive follow-up.
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Shigeyasu C, Yamada M, Mizuno Y, Yokoi T, Nishina S, Azuma N. Clinical features of anterior segment dysgenesis associated with congenital corneal opacities. Cornea 2012;31:293–8. doi: 10.1097/ICO.0b013e31820cd2ab.
Karadag R, Rapuano CJ, Hammersmith KM, Nagra PK. Causes of congenital corneal opacities and their management in a tertiary care center. Arq Bras Oftalmol. 2020;83:98–102. doi: 10.5935/0004-2749.20200023.
Yulia DE, Putri FM, Soeharto DA. Clinical profile of Indonesian children with anterior segment dysgenesis as a contributor for childhood blindness. Clin Epidemiol Glob Health. 2023;20:2213–3984. https://doi.org/10.1016/j.cegh.2023.101258.
Rezende RA, Uchoa UB, Uchoa R, Rapuano CJ, Laibson PR, Cohen EJ. Congenital corneal opacities in a cornea referral practice. Cornea. 2004;23:565–70. doi: 10.1097/01.ico.0000126317.90271.d8.
Borik K, Mohney BG, Hodge D, Reynolds MM. Birth prevalence and characteristics of congenital corneal opacities. Eur J Ophthalmol.2024;34:734–8. doi: 10.1177/11206721231202900.
Rajagopal RN, Fernandes M. Peters anomaly: novel non-invasive alternatives to penetrating keratoplasty. Semin Ophthalmol.2023;38:275–82. doi: 10.1080/08820538.2023.2176238.
American Academy of Ophthalmology. Pediatric ophthalmology and strabismus. In: Khan A, Chang TC, El-Dairi MA, Lee KA, Utz VM, Mireskandari K, et al., editors. 2022–2023 Basic and clinical science course. San Fransisco (CA): American Academy of Ophthalmology;2022.
Congenital corneal opacities - Asia Pacific [Internet]. San Fransisco (CA): American Academy of Ophthalmology; 2015 [cited 2024 Oct 1]. Available from: https://www.aao.org/education/topic-detail/congenital-corneal-opacities-asia-pacific.
Katzman LR, Reiser BJ. Pediatric corneal opacities [Internet]. San Fransisco (CA): American Academy of Ophthalmology; 2016 [cited 2024 Oct 1]. Available from: https://www.aao.org/education/disease-review/pediatric-corneal-opacities.
Kusumesh R, Vanathi M. Graft rejection in pediatric penetrating keratoplasty: clinical features and outcomes. Oman J Ophthalmol. 2015 Jan–Apr;8(1):33–7. doi: 10.4103/0974-620X.149862.
Abukahel A, Aldiwanie AS, Alryalat SA, Gharaibeh AM. Indications and outcomes of pediatric penetrating keratoplasty: a retrospective observational study. Med Hypothesis Discov Innov Ophthalmol. 2022 Apr 1;11(1):27–33. doi: 10.51329/mehdiophthal1442.
Shi W, Jin H, Li S, Liu M, Xie L. Indications of paediatric keratoplasty in north China. Clin Exp Ophthalmol. 2007;35:724–7. doi: 10.1111/j.1442-9071.2007.01618.x.
Chang KC, Kwon JW, Han YK, Wee WR, Lee JH. The epidemiology of cosmetic treatments for corneal opacities in a Korean population.Korean J Ophthalmol. 2010;24:148–54. doi: 10.3341/kjo.2010.24.3.148.
Patel HY, Ormonde S, Brookes NH, Moffatt LS, McGhee CN. The indications and outcome of paediatric corneal transplantation in New Zealand: 1991–2003. Br J Ophthalmol. 2005;89:404–8. doi: 10.1136/bjo.2004.053116.
Michaeli A, Markovich A, Rootman DS. Corneal transplants for the treatment of congenital corneal opacities. J Pediatr Ophthalmol Strabismus. 2005;42:34–44. doi: 10.3928/01913913-20050101-05.
Miao S, Lin Q, Liu Y, Song YW, Zhang YN, Pan ZQ. Clinicopathologic features and treatment characteristics of congenital corneal opacity infants and children aged 3 years or less: a etrospective single institution analysis. Med Princ and Pract. 2019;29:18. doi: 10.1159/000501763.
Belayneh YM, Amberbir G, Agalu A. A prospective observational study of drug therapy problems in medical ward of a referral hospital
in northeast Ethiopia. BMC Health Serv Res. 2018;18:1–7. doi: 10.1186/s12913-018-3612-x.
Huang C, O’Hara M, Mannis MJ. Primary pediatric keratoplasty: indications and outcomes. Cornea. 2009;28:1003–8. doi: 10.1097/ ICO.0b013e3181a186c0.
Dana MR, Moyes AL, Gomes JA, Rosheim KM, Schaumberg DA, Laibson PR, et al. The indications for and outcome in pediatric keratoplasty. a multicenter study. Ophthalmology. 1995;102:1129–38. doi: 10.1016/s0161-6420(95)30900-1.
Mun-Wei L, Said HM, Punitan R, Ibrahim M, Shatriah I. Indications, clinical outcomes, and survival rate of pediatric penetrating keratoplasty in suburban Malaysia: a 10-year experience. Cureus. 2018;10:e3744. doi: 10.7759/cureus.3744.
Gurnani B, Kaur K, Chaudhary S, Kaur RP, Nayak S, Mishra D, et al. Pediatric corneal transplantation: techniques, challenges, and outcomes. Ther Adv Ophthalmol. 2024;16:25158414241237906. doi: 10.1177/25158414241237906.
Trief D, Marquezan MC, Rapuano CJ, Prescott CR. Pediatric corneal transplants. Curr Opin Ophthalmol. 2017;28:477–84. doi: 10.1097/ ICU.0000000000000393.
Lowe MT, Keane MC, Coster DJ, Williams KA. The outcome of corneal transplantation in infants, children, and adolescents. Ophthalmology. 2011;118:492–7. doi: 10.1016/j.ophtha.2010.07.006.
Karadag R, Chan TC, Azari AA, Nagra PK, Hammersmith KM, Rapuano CJ. Survival of primary penetrating keratoplasty in children. Am J Ophthalmol. 2016;171:95–100. doi: 10.1016/j.ajo.2016.08.031.
Zhang Y, Liu Y, Liang Q, Miao S, Lin Q, Zhang J, et al. Indications and outcomes of penetrating keratoplasty in infants and children of Beijing, China. Cornea. 2018;37:1243–8. doi: 10.1097/ICO.0000000000001695.
Lin Q, Shi W, Miao S, Zhang Y, Li L, Pan Z. Visual outcomes and prognostic factors of successful penetrating keratoplasty in 0- to 7-year-old children with congenital corneal opacities. Cornea. 2018;37:1237–42. doi: 10.1097/ICO.0000000000001689.
Yang LL, Lambert SR, Drews-Botsch C, Stulting RD. Long-term visual outcome of penetrating keratoplasty in infants and children with peters anomaly. J AAPOS. 2009;13:175–80. doi: 10.1016/j.jaapos.2008.10.007.
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