Pediatric corneal transplantation: techniques, challenges, and outcomes.

Pediatric corneal transplant is a highly demanding and technically challenging procedure for the cornea surgeon in today's era. These cases pose unique challenges in clinical and surgical management. The indications of pediatric corneal transplant can be therapeutic, tectonic, optical, and cosmetic. Pediatric patients undergoing corneal transplants are at a high risk of graft infection, failure, rejection, dehiscence, and amblyopia due to young age, robust immune system, increased incidence of trauma, and compliance issues. The other factors contributing to graft failure can be allograft rejection, secondary glaucoma, corneal vascularization, multiple surgeries, vitreous prolapse, and lack of treatment compliance. A successful corneal transplant in children depends on meticulous preoperative evaluation, uneventful surgery, the expertise of a corneal surgeon, and regular and timely postoperative follow-up. Therapeutic and optical penetrating keratoplasty are the most commonly performed transplants in children. However, with the advancements in surgical technique and management protocol, the current focus has shifted toward lamellar keratoplasty. Lamellar keratoplasty offers early visual recovery and potentially fewer complications. Visual rehabilitation through corneal transplant in otherwise blind eyes can be a boon for the children. Recently, keratoprostheses have been promising in children with multiple graft failures. The current review gives insights into epidemiology, etiology, indications, clinical characteristics, investigations, management options, recent advances, and the future of pediatric corneal transplants. As surgical techniques continue to grow and comprehension of pediatric corneal transplants is improving, we can safeguard these eyes with the best possible anatomical and functional outcomes.

Intricate insights into immune response in dry eye disease.

Dry eye disease (DED) is a complex disorder of the ocular surface with a loss of tear film homeostasis, causing an imbalance in the tear-air interface and leading to ocular discomfort, pain, and vision issues. Immune control issues are a primary factor in dry eye disorder's origin, progression, and management. The aim of managing DED is to reduce symptoms and improve the life quality of those affected. Despite the diagnosis, up to half of the patients do not get proper care. The scarcity of successful treatments for DED is worrisome, and it is of increasing importance to comprehend the root causes and create more effective therapies to alleviate the distress of those afflicted with the disorder. Therefore, the role of the immune system in the initiation and progression of DED has become the research focus. This paper reviews the current insight into the immune response in DED, the existing treatment methods, and ongoing research to search for better treatments.

Arc flash macular hole.

Macular holes are common. Lightening, direct electric shock induced and laser beam induced macular holes are though rare. Reporting a case of spark flashlight (Arc Flash) induced macular hole in an electrician, which has never been reported. A 19 year old male electrician by profession presented to our clinic with a history of exposure to a bright flash light from spark of wires while at work that led to decrease of vision in his both eyes. Examination revealed a full thickness macular hole in his right eye and loss of foveal photoreceptors in the left eye. Arc flash light exposure in electricians can lead to macular holes too adding a new entity to the already existing types of macular holes.