THE INDICATIONS FOR AND OUTCOME IN PEDIATRIC KERATOPLASTY - A MULTICENTER STUDY

Purpose: A multicenter study was undertaken to delineate the indicatio ns for and outcome of pediatric keratoplasty. Methods: The authors ret rospectively studied 164 grafts in 131 eyes of 108 children younger th an 12 years of age, with an average follow-up of 45 months. Multivaria te linear and logistic regression was performed to evaluate potential risk factors for poor visual outcome and graft failure. Graft survival was depicted in terms of the Kaplan-Meier survival curve. Results: Co rneal opacities were grouped into three diagnostic categories: congeni tal (64%), traumatic (17%), and acquired nontraumatic (19%) opacities. Overall graft survival was 80% at 12 months and 67% at 24 months post operatively. There was no significant difference in retention of clari ty among diagnostic groups. Vitrectomy-lensectomy, regrafts, and posto perative complications were associated significantly with poor allogra ft survival. Eighteen percent of all eyes had worse vision at the time of the last visit than preoperatively. Amblyopia treatment was the on ly independently significant prognosticator for visual improvement aft er surgery. Timing of keratoplasty was not demonstrated to be associat ed with visual outcome. Visual acuity in 33% of eyes that could be qua ntified was better than 20/200 at the last visit, whereas 62% of eyes retained full graft clarity. Conclusion: The authors conclude that ker atoplasty can be successful in most children, especially when combined with appropriate amblyopia management.