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Oversized grafts in children
R B Vajpayee1, M Ramu, A Panda
1Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi.
Objective:
To evaluate the efficacy of oversized corneal grafts in the pediatric age group.
Design:
Prospective, nonrandomized clinical trial.
Participants And Intervention:
Forty pediatric patients with unilateral or bilateral corneal opacification of congenital or acquired origin underwent corneal grafting surgery over a period of 2 years using donor corneal buttons oversized by 1 mm.
Main Outcome Measures:
The parameters evaluated were indications for keratoplasty, graft clarity, visual acuity, keratometry, spherical equivalent, anterior chamber depth, and complications.
Results:
Corneal ulceration was the most common cause of corneal opacification (25%), followed by trauma (20%) and sclerocornea (20%). At 1 year, clear grafts were achieved in 85% of the cohort. The average keratometry at the end of 1 year was 43.28 +/- 1.65 diopters (D) in the congenital opacity group and 43.04 +/- 2.20 D in the acquired group. The keratometric astigmatism was 3.60 +/- 2.60 D in the congenital group and 2.52 +/- 2.20 D in the acquired group. Oversized grafts provided an adequate anterior chamber depth of 2.20 +/- 0.612 mm in the congenital group and 2.36 +/- 0.302 mm in the acquired group. Visual acuity of 20/80 or better was recorded in only 30% of cases in the congenital group as opposed to 47% with acquired opacities. Nine cases had episodes of graft rejection.
Conclusion:
Oversizing donor buttons by 1 mm provides adequate anterior chamber depth and increases the morphologic success of corneal grafting in children.
