CORNEAL TRANSPLANTATION IN CHILDREN WITH PETERS ANOMALY AND MESENCHYMAL DYSGENESES

Objective: The purpose of the study is to describe graft and visual ou tcomes of penetrating keratoplasty among young children with Peters an omaly and associated mesenchymal dysgeneses. Design: The design was a multicenter retrospective analysis of the indications and outcome in p ediatric keratoplasty. Participants: The records of all children aged 12 years and younger who underwent penetrating keratoplasty for mesenc hymal dysgenesis between January 1975 and May 1993 at the participatin g centers were reviewed. Measures: The data were analyzed regarding gr aft survival and postoperative visual acuity. Results: Forty-seven cor neal transplants in 36 eyes of 29 patients with mesenchymal dysgenesis were studied. The majority of eyes operated on (30) had Peters anomal y (83%). Patients' mean age at the time of keratoplasty was 7 months. After a mean followup period of 38 months, 61% of eyes retained full g raft clarity. One and 3-year survival rates were 79% (95% confidence i nterval [CI] = 65%-93%) and 62% (95% CI = 45%-79%), respectively. Post operative corneal ulcers/nonhealing epithelial defects (P = 0.03), and additional noncorneal surgical procedures at the time of transplantat ion (P = 0.05) were associated with graft failure. Provision of postop erative optical aids (P = 0.01) was associated with better postoperati ve visual acuity levels. Conclusions: Penetrating keratoplasty for Pet ers anomaly and related mesenchymal dysgeneses in young children has a reasonable chance of success during the critical years of visual matu ration and is associated with satisfactory visual results in one third to half the cases. The data suggest that complicated cases requiring additional surgical procedures have a worse prognosis.