Penetrating keratoplasty in infants

Purpose: To analyze graft survival and visual outcome after penetrating ker atoplasty in infants with congenital corneal opacity. Methods: We retrospec tively reviewed the records of 11 patients with congenital corneal opacity who underwent penetrating keratoplasty as infants. Six patients had a diagn osis of Peter's anomaly, 1 of congenital hereditary endothelial dystrophy, 1 of posterior polymorphous dystrophy, and 2 of sclerocornea, and in the ot her patient, the cause of the opacity was unknown. Results. In total, 26 pe netrating keratoplasties were performed on 16 eyes of 11 infants. All patie nts initially underwent surgery before the age of 13 months. Five patients underwent bilateral penetrating keratoplasty, and 10 of the transplants wer e repeat operations on eyes that had already had at least one previously fa iled graft. The age of the infants at the time of first penetrating keratop lasty ranged from 2 to 56 weeks (median, 13 weeks). The graft survival time for all transplants ranged from 3 to 137 months (median, 16 months). Overa ll first graft survival at 12 months was 61% (95% Cl, 33%-81%), with 10 of 16 eyes retaining a clear corneal graft. Peter's anomaly, lensectomy, and r epeat penetrating keratoplasty were factors most highly associated with poo r graft survival and a low final visual acuity. Conclusion: Early penetrati ng keratoplasty for congenital corneal opacity may prevent deprivation ambl yopia. Although this procedure carries a high risk of failure, particularly in those patients with Peter's anomaly, careful case selection, optical co rrection, and management of postoperative amblyopia may result in a success ful visual outcome.