Penetrating keratoplasty in children

Purpose, To determine the success of penetrating keratoplasty in the presen ce of various pediatric corneal abnormalities. Methods. We performed a retr ospective study of pediatric corneal grafts at L.V. Prasad Eye Institute, H yderabad, India. Outcome of pediatric corneal transplantation was evaluated in terms of anatomic and optical success and factors contributing to poor graft survival. On the basis of the corneal pathology, patients were divide d into three categories: congenital. acquired nontraumatic, and acquired tr aumatic. Results. A retrospective analysis of 154 penetrating keratoplastie s performed in 140 children, aged 14 years or younger, was done. The averag e follow-up was 1.3 years (range, 1 week-5 years). Grafts remained clear in 102 (65.2%) of 154 eyes. Clear grafts were achieved in 30 (63.8%) of 47 ey es with congenital opacities, 12 (54.5%) of 22 eyes with opacities from tra uma, and 60 (70.6%) of 85 eyes with acquired nontraumatic opacities. Most ( 26 of 52) of the graft failures occurred during the first 26 weeks after su rgery. Survival analysis revealed the probability of a graft remaining clea r at the end of 26 weeks as 80% (SE, 3.39%). Poor graft survival could be c orrelated with those younger than 5 years (p = 0.0341) and performance of a nterior vitrectomy (p = 0.0002). Most grafts failed because of allograft re jection (42.3%), infectious keratitis (26.9%). or secondary glaucoma (13.4% ). Postoperatively, 53 eyes had greater than or equal to 20/400 vision, 29 of which had greater than or equal to 20/50. Vision could not be assessed i n 33 eyes because of the young age. Conclusion. Whereas anatomic success of pediatric keratoplasty is increasing, optical success continues to remain less than satisfactory. Early surgical intervention and intensive amblyopia therapy may promote visual recovery.