Abstract
Purpose::
To determine the factors which influenced the development of good vision in children who had corneal transplant surgery (CTS) at a young age for Peters anomaly Type I (PA-I).
Design::
Retrospective review of interventional case series of infants who underwent CTS from 1987 - 2003.
Methods::
Twenty-six eyes of 21 children currently greater than three years of age had undergone CTS for PA-1 as infants (age two - 18 months). The children were now divided into two groups for analysis: Group 1 included those patients who achieved vision of 20/100 or better. Group 2 included patients with vision worse than 20/100. The factors evaluated were age at surgery, patient compliance, glaucoma, corneal ulcer, immunologic rejection, regraft, astigmatism, and cataract extraction (CE).
Results::
There were 13 eyes in each group. In Group 1, the average age at surgery was 4.46 months. One eye (7.7%) had poor compliance. Six eyes (46%) had glaucoma, all controlled by medical therapy. One eye (7.7%) had a corneal ulcer. Three eyes (23%) had rejection episodes. No eyes had failed grafts or a regraft. Five eyes (38%) had astigmatism of ≥ 2.00 D. One eye (7.7%) required CE. Seven eyes had vision of 20/50 or better.In Group 2, the average age at surgery was 5.73 months. Two eyes (15%) had poor compliance. Nine eyes (69%) had glaucoma; three required surgery. Two eyes (15%) had corneal ulcers. Five eyes (38%) had rejection episodes. Four eyes (31%) had failed grafts: two from glaucoma, and two following rejection. Seven eyes (54%) had astigmatism ≥ 2.00 D. Six eyes (46%) required CE.
Conclusions::
The major differences between the two groups were in the incidence and severity of glaucoma, the incidence of CE and the amount of astigmatism. Group 2 had more of these complications. Eyes in Group 2 had surgery five weeks later than in Group 1. Corneal surgeons cannot control every aspect of the postoperative care of children with CTS. We conclude that to improve the visual results in infants having CTS for PA-1, glaucoma and astigmatism should be better controlled. Also, it is possible that surgery should be done earlier in these children.
Keywords: cornea: clinical science • visual development: infancy and childhood • clinical (human) or epidemiologic studies: outcomes/complications