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H.Y. Hsu, M. Wang, J.C. Song; The CHLA Pediatric Corneal Transplant Experience: The Surgical Outcomes . Invest. Ophthalmol. Vis. Sci. 2003;44(13):4679.
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Purpose: Pediatric corneal transplantation is different from adult transplantation not only in the surgical techniques but also in the indications and outcomes. We explored the indications and surgical outcomes for pediatric corneal transplantation at our institution. Method: We performed a retrospective review of pediatric corneal transplants at the Childrens Hospital of Los Angeles from February 1999 to June 2002. The indications were divided into three categories: congenital, acquired traumatic, and acquired non-traumatic. The decompensation and rejection rates were also evaluated. Results: Fifty-seven transplants were performed on 47 eyes of 40 patients. The follow-up was a minimum of 6 months. There were 39 transplants on 26 patients done for congenital conditions (Peter’s anomaly, keratoconus, scerocornea, and CHED being the most common). In the acquired traumatic group, there were 9 transplants performed on 9 patients (traumatic corneal scars being the most common indication). In the acquired non-traumatic group, 9 transplants were performed on 5 patients (7 on 4 patients with bacterial corneal ulcers). Thirty-six (63%) of the grafts remained clear (the longest survival times was 3.5 years). Twenty-one (37%) of the grafts failed from either graft decompensation (9) or rejections (12). Nine eyes were re-transplanted (4 due to decompensation, 4 from rejection, and 1 from trauma), and one graft was reattached after blunt trauma. Of the 9 eyes that decompensated, 7 were in 2 patients with Peter’s anomaly, 1 due to trauma, and 1 in a patient with congenital glaucoma. Of the 12 transplants (8 patients) that rejected, 7 were in patients with corneal ulcers, 4 in sclerocornea (3 out of 5 patients), and 1 in Peter’s. Therefore, the graft survival was 64% in the congenital group, 100% in the acquired traumatic group, and 22% in the acquired non-traumatic group (0% in the corneal ulcer group). Conclusion: Indications for pediatric corneal transplants differ from those of adults in that the majority (68%) are performed for congenital conditions. Peter’s anomaly carries the greatest risk for graft decompensation, and transplants for corneal ulcers in children carry the worse prognosis.
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