Abstract
Purpose :
A clear visual axis is crucial to allow for visual development in patients with congenital and other forms of corneal opacities during childhood. Although surgical transplantation is considered the most effective treatment, pediatric keratoplasty is a challenging procedure and only accounts for approximately 5% of total corneal transplants. In this study, we evaluate the long-term outcomes of pediatric patients who underwent keratoplasty at a tertiary care center.
Methods :
A retrospective review was completed of patients aged 16 and younger who underwent surgical treatment for corneal decompensation. Seventy-two eyes of 46 patients met inclusion criteria with a minimum follow-up of 6 months. Initial diagnosis, comorbid ocular conditions, surgical procedure, and post-operative outcomes were analyzed.
Results :
The most common indications for keratoplasty were Peters anomaly (22%), corneal scar (14%), and congenital hereditary endothelial dystrophy (14%). The mean patient age at time of transplantation was 7.44 years (range, 11 days-20.09 years) and average follow-up time was 6.04 years (range, 8 months-17 years). The most common surgical procedure was penetrating keratoplasty (67%) followed by descemet stripping endothelial keratoplasty (15%), deep anterior lamellar keratoplasty (8%), and keratoprosthesis (6%). Forty eyes (56%) had graft failure occurring at a mean time of 16.33 months (range, 27 days-12.58 years), of which 25 eyes (62.5%) underwent a secondary keratoplasty procedure. Patients who underwent keratoplasty alone had significantly less graft failure compared to those who had combination procedures such as keratoplasty + glaucoma shunt, retinal detachment repair, or lensectomy (43% vs 55%, p=0.008). Further, graft failure rates decreased significantly when partial thickness procedures were performed compared to full thickness (15% vs 83%, p=0.008).
Conclusions :
Keratoplasty in the pediatric population has a high rate of graft failure. Despite this, pediatric keratoplasty offers visual rehabilitation for patients with corneal decompensation from a variety of etiologies. Graft failure rates significantly decreased when keratoplasty was performed alone and with partial thickness operative procedures.
This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.