PENETRATING KERATOPLASTY IN INFANTS WITH CONGENITAL GLAUCOMA

The efficacy of corneal transplantation in infants with corneal opacit y secondary to congenital glaucoma has not been established. We retros pectively reviewed our results of nine penetrating keratoplasties perf ormed on eight eyes of six infants who had multiple risk factors for p oor prognosis: age < 2 years at the time of grafting; uncontrolled gla ucoma in four eyes; concurrent lensectomy, retinal, or glaucoma surger y in five eyes; aphakia in five eyes; and an acute perforation in one eye. Six of the nine grafts (67%) remained clear during a mean follow- up of 24 months (30 months in eyes with clear grafts). Development of ambulatory vision or better occurred in six of eight (75%) eyes after corneal transplantation and treatment of refractive errors and amblyop ia. Graft failure occurred in three eyes-two from corneal decompensati on, and one from homograft rejection. Complications included one total retinal detachment, one case of Streptococcus pneumoniae keratitis, a nd three cases that lost intraocular pressure control, requiring furth er glaucoma surgery. We conclude that useful vision can be achieved af ter penetrating keratoplasty even in some high-risk infants with conge nital glaucoma.