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Anna Djougarian, Gerald W. Zaidman; Long-Term Outcome of Corneal Transplant Surgery in Pediatric Patients with Keratoconus. Invest. Ophthalmol. Vis. Sci. 2012;53(14):6053. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
To investigate the outcome of corneal transplant surgery (CTS) in children with keratoconus (KCN).
Four years ago a retrospective chart review was conducted of all children under 18 years of age that had CTS for KCN from 2000-2008. This is a follow-up study including data from 2000-2011. We also include eyes that were not operated on in patients with bilateral KCN.
37 eyes of 21 patients with KCN were analyzed. 26 eyes had CTS. 7 were girls, 14 were boys. The average age of the patients was 15.8 years, ranging from 10 to 18. Eighteen of the 21 patients had bilateral disease. Seven patients had bilateral penetrating keratoplasty, two of which were done at age >18, and therefore are not included in this study. Six eyes presented with hydrops. One patient had bilateral hydrop. The best-corrected visual acuity (BCVA) at presentation of all eyes that did not have hydrops was recorded. Of the eyes that were operated on, 6 eyes had BCVA of 20/30-2/50, 6 eyes had BCVA of 20/70-20/100, 7 eyes had BCVA of 20/150-20/400 and 1 eye was counting fingers (CF). Of the eyes that were not operated on, 5 eyes had BCVA of 20/25 or better, 5 eyes had BCVA of 20/30-20/40, and 1 eye was 20/100. Mean K value at presentation of operated eyes was 53.3. Mean K value at presentation of unoperated eyes was 49.2. The average time from presentation to surgery was 0.7 years, ranging from 16 days to 2.8 years. The average length of time to the last follow up exam was 2.6 years, ranging from 0.02 years to 12.5 years. 25 of the 26 eyes had clear grafts. 13 eyes experienced graft rejection episodes and 12 cleared after treatment. One graft failed due to a graft rejection. 1 eye developed medically controlled glaucoma. No eyes developed cataracts. 22 of the 25 (85%) eyes with clear grafts had a BCVA >20/40. 10 of the 25 eyes (40%) with clear grafts were 20/25 or better. One eye was 20/60 and one was CF, in two patients lost to follow-up less than 2 months after surgery. One eye was 20/100, due to a wound dehiscence after blunt corneal trauma.
85% of pediatric patients with keratoconus did well following corneal transplant surgery with excellent visual recovery. There was a 50% incidence of graft rejection but nearly all cleared with medical therapy.
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