Oversized grafts in children

Objective: To evaluate the efficacy of oversized corneal grafts in the pedi atric age group. Design: Prospective, nonrandomized clinical trial. Participants and Intervention: Forty pediatric patients with unilateral or bilateral corneal opacification of congenital or acquired origin underwent corneal grafting surgery over a period of 2 years using donor corneal butto ns oversized by 1 mm. Main Outcome Measures: The parameters evaluated were indications for kerato plasty, graft clarity, visual acuity, keratometry, spherical equivalent, an terior chamber depth, and complications. Results: Corneal ulceration was the most common cause of corneal opacificat ion (25%), followed by trauma (20%) and sclerocornea (20%), At 1 year, clea r grafts were achieved in 85% of the cohort. The average keratometry at the end of 1 year was 43.28 +/- 1.65 diopters (D) in the congenital opacity gr oup and 43.04 +/- 2.20 D in the acquired group. The keratometric astigmatis m was 3.60 +/- 2.60 D in the congenital group and 2.52 +/- 2.20 D in the ac quired group. Oversized grafts provided an adequate anterior chamber depth of 2.20 +/- 1.612 mm in the congenital group and 2.36 +/- 1.302 mm in the a cquired group. Visual acuity of 20/80 or better was recorded in only 30% of cases in the congenital group as opposed to 47% with acquired opacities. N ine cases had episodes of graft rejection. Conclusion: Oversizing donor buttons by 1 mm provides adequate anterior cha mber depth and increases the morphologic success of corneal grafting in chi ldren.