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Angela Zhu, Christina Rapp Prescott; Surgical trends in pediatric corneal transplantation in the United States. Invest. Ophthalmol. Vis. Sci. 2018;59(9):1329.
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Pediatric corneal opacities are important causes of childhood blindness, ranging in etiology from congenital dystrophies to acquired conditions. Corneal transplantation remains the standard treatment, but there is little consensus regarding surgical decision-making and peri-operative management for these patients. We aim to assess cross-sectional data from eye banks who provide corneal donor tissue to pediatric recipients around the United States to characterize surgical trends in pediatric keratoplasty over the past 10-15 years. We can then compare this to subjective preferred practice patterns to analyze the changing field of pediatric corneal transplantation as surgical technologies continue to evolve.
We performed a retrospective review of data collected from individual eye banks and associations (KeraLink International) for recipient data of pediatric patients (<18 years) who underwent corneal transplantation between January 2004 and August 2017. We analyzed trends in indications for surgery and preoperative diagnoses, types of keratoplasty performed, and donor/recipient characteristics between different recipient age groups and over time. Two-tailed Student’s t-test and analysis of variance (ANOVA) were used for statistical analysis.
Our database included 310 total keratoplasties performed in recipients age 18 and younger; 31.3% in ages 0-5 years, 25.5% in ages 6-12, and 43.2% in ages 13-18. Of those, 91.6% were penetrating keratoplasty (PKP) and 4.2% were Descemet stripping endothelial keratoplasty (DSEK), but 76.9% of DSEK cases were performed after 2008. Transplant indications were only reported in 28.1% of cases, but the primary reported indication was congenital opacities (27.6%) especially in ages 0-5 years. Average donor age was significantly younger for PKP recipients (23.4 years) than in other cases (53.6 years, p<0.01).
Congenital corneal opacity remains the primary indication for transplantation for age <5 years, while acquired conditions (post-cataract edema, ectasia) may be equally likely in older pediatric populations. PKP continues to be the most common pediatric keratoplasty performed, though more partial-thickness transplants are being performed since 2008. Surgeons may be requesting younger donor tissue for full-thickness PKP than other procedures, and they may accept lower donor endothelial cell counts for lamellar or anterior keratoplasty.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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