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A.J. Fell, G. Nießen, H. Nikbacht, K. Engelmann; Outcome in First Penetrating Keratoplasty in Children and Adolescents . Invest. Ophthalmol. Vis. Sci. 2003;44(13):4698.
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Purpose: To determine graft survival and visual outcome after first penetrating keratoplasty in children and adolescents. Methods: The retrospective study includes first grafts in children and adolescents aged eighteen years or younger. Patients with prior corneal grafts and/or keratoplasty in the contralateral opposite eye were excluded in order to not alter statistical analysis. Results: The average follow-up of 59 penetrating keratoplasties was 3.5 (+/- 2.6) years. Patients were grouped into three diagnostic categories: congenital opacities (18), traumatic (13) and acquired non-traumatic opacities (28). There was no significant difference between occurrence of opacity and graft failure in any group. Overall graft survival was 81% one year after surgery, and 76% and 69% three and five years after surgery, respectively. However, the occurrence of graft failure was significantly more likely in children younger than six years (12 of the 22 patients) than in patients aged 7 to 18 years (7 of the 37) (significance p < 0.005). After suture removal 19 patients achieved a vision of > 20/40, 7 patients achieved a vision between 20/200 and 20/40, and 17 patients had a vision of < 20/200. No vision could be assessed in 16 patients. In 34 patients astigmatism was observed with an average of 4.2 (+/-2.4) diopters after suture removal. Conclusion: Children aged younger than 6 years do have a higher incidence of graft failure after penetrating keratoplasty than those between 7 and 18 years. Indication for keratoplasty in these patients should be considered carefully. More frequent follow-up examinations after keratoplasty are advised. Despite the difficulties and the high incidence of graft failure we found that early surgical intervention and resolute amblyopia therapy improved visual outcome in case of graft survival.
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