Corneal transplantation in children-when and how?

IntroductionAdvanced surgical techniques, better post-operative protocols, imaging, and better understanding of genetic basis have enhanced outcomes of pediatric keratoplasty. However, results in infants and younger children remain a challenge. Transplants in the pediatric age group are challenging because of the complexity of the indications, the procedure itself, and the problems with respect to follow-up and post-operative care in younger recipients.Areas coveredThis review presents an overview of challenges faced in the management of pediatric corneal grafts, and problems encountered in long-term survival. We discuss the changing trends in these outcomes of PKP with a current review of the recent literature from PubMed. We also share the results of pediatric keratoplasty done at our center in the last three years and have an in-depth discussion about the management of comorbidities like cataracts and glaucomaExpert opinionDespite several advances in microsurgical techniques for corneal transplantation, pediatric keratoplasty remains challenging due to a variety of factors such as young age, repeated need for anesthesia, immature ocular tissues, and accelerated healing. The advent of component surgeries like DALK, DSEK, and DMEK has improved outcomes and simplified management options. Even after specialized surgeries, long-term follow-ups and management of comorbidities become essential.