title: The challenging management of pediatric corneal transplantation: an overview of surgical and clinical experiences.
abstract: OBJECTIVE
  Pediatric keratoplasty is an immense challenge because of the technical complexity of the procedure and the high risk of rejection in young graft recipients. Our aim is to describe the major indications and appropriate timing of corneal transplantation intervention, including a report of our experience and surgical tips, in conjunction with the current literature.
  
  
  METHODS
  Review of the literature on indications for keratoplasty in pediatric patients classified as: congenital, traumatic and acquired non-traumatic opacities. We additionally explored the challenges corneal surgeons face in performing this type of surgery and review the most pressing transplant-related problems and their management.
  
  
  RESULTS
  Outcomes after pediatric keratoplasty, in terms of visual development, restoration and clarity of the graft, are influenced by peri-operative local and systemic conditions and factors, and by intraoperative management of the transplantation procedure itself.
  
  
  CONCLUSIONS
  Pediatric corneal transplantation is a critical tool for visual restoration and development in young patients with corneal opacities, particularly during the critical period of visual development. Successful management of the significant challenges associated with pediatric keratoplasty requires customized clinical and surgical management of each patient with particular attention paid to proper post-operative rehabilitation.
authors.affiliation: IRCCS G.B. Bietti Foundation ONLUS, via Livenza n.3, 00198, Rome, Italy. Antonio_dizazzo@yahoo.com.
authors.forename: Antonio
authors.initials: A
authors.lastname: Di Zazzo
authors.affiliation: Department of Ophthalmology, University Campus Bio-Medico of Rome, Rome, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Bonini
authors.affiliation: Humanitas Group, Mater Domini Hospital, Castellanza, Italy.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Crugliano
authors.affiliation: IRCSS Bambino Gesù Pediatric Hospital, Rome, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Fortunato
mesh_terms: D002648:Child; D003315:Cornea / Q000473:pathology / Q000601:surgery*; D003318:Corneal Opacity / Q000473:pathology / Q000503:physiopathology / Q000601:surgery; D016039:Corneal Transplantation / Q000379:methods*; D006085:Graft Survival; D006801:Humans; D014792:Visual Acuity
keywords: Congenital disease; Corneal transplantation; Pediatric; Peter’s anomaly