Abstract
Purpose :
Penetrating keratoplasty (PK) is an effective surgical technique for the management of a wide range of corneal pathologies. Corneal transplants performed in pediatric patients have higher rates of graft failure compared to adults. The purpose of this study was to describe the indications for and outcomes of PK in the pediatric population using a large electronic health record registry.
Methods :
Pediatric patients (aged 0 to 18 years) in the Intelligent Research in Sight (IRIS) Registry who underwent PK between 2013 and 2020 were identified using Current Procedure Terminology codes. Underlying diagnoses were determined based on International Classification of Diseases (ICD) Revision 9 and 10 codes. Data collected included patient demographics, indication for surgery, incidence of graft failure, and post-operative complications. Indications for PK were categorized as i) acquired traumatic (Tears in the Descemet membrane, etc.), ii) acquired non-traumatic (infectious ulcers, Steven-Johnson syndrome, etc.), or iii) congenital (Peters anomaly, aniridia, sclerocornea, etc.).
Results :
544 patients who underwent PK were identified. The median age was 15 (IQR 9-17), 56.6% were male, 43% were female and 0.4% were of unspecified gender. The indications for surgery were underlying traumatic acquired etiology in 201 (44%), non-traumatic acquired etiology in 190 (41%), and congenital etiology in 71 (15%) of patients. The cumulative incidence of graft failure at five years for all patients was 51%. The five-year cumulative incidence of graft failure in patients with acquired non-traumatic, acquired traumatic and congenital indications for surgery were 53%, 52% and 48%, respectively. Post-operative complications were noted in 326 patients (60.0%) and included infectious keratitis (n=139, 25.6%), glaucoma (n=71, 13.1%), retinal detachment (n=40, 7.4%), endophthalmitis (n=12, 2.2%), and neurotrophic keratitis (n=10, 1.8%). At 5 years post-PK, 15% of patients had undergone repeat PK.
Conclusions :
Approximately half of children undergoing PK in the IRIS Registry experienced graft failure within five years. This study illustrates the challenges associated with pediatric PK, including a relatively low rate of graft survival and high incidence of post-operative complications.
This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.