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Penetrating keratoplasty in children
1L.V. Prasad Eye Institute, Hyderabad, India. murali@lvpeye.stph.net
Insights
Penetrating keratoplasty in children shows increasing anatomic success but less satisfactory optical outcomes. Factors like younger age and anterior vitrectomy impact graft survival, necessitating early intervention and amblyopia therapy for better visual recovery.
Area of Science:
- Ophthalmology
- Corneal Surgery
- Pediatric Eye Care
Background:
- Pediatric corneal abnormalities present unique challenges for vision restoration.
- Penetrating keratoplasty (PKP) is a surgical option for corneal opacity in children.
- Evaluating PKP outcomes in pediatric populations is crucial for improving surgical strategies.
Purpose of the Study:
- To assess the success rates of penetrating keratoplasty in children with diverse corneal conditions.
- To identify factors influencing graft survival and visual outcomes in pediatric corneal transplantation.
Main Methods:
- Retrospective analysis of 154 PKPs in 140 children (≤14 years) at L.V. Prasad Eye Institute.
- Categorization of corneal pathologies into congenital, acquired nontraumatic, and acquired traumatic.
- Evaluation of anatomic and optical success, with follow-up up to 5 years.
Main Results:
- Overall graft clarity was 66.2% (102/154 eyes).
- Clear grafts were achieved in 63.8% (congenital), 54.5% (traumatic), and 70.6% (nontraumatic) of eyes.
- Graft failure was linked to younger age (<5 years) and anterior vitrectomy; common causes included rejection, infectious keratitis, and glaucoma.
Conclusions:
- Pediatric keratoplasty demonstrates improving anatomic success but suboptimal optical results.
- Early surgical intervention and aggressive amblyopia management are vital for visual rehabilitation.
- Further research is needed to enhance optical success in pediatric corneal transplantation.
Purpose:
To determine the success of penetrating keratoplasty in the presence of various pediatric corneal abnormalities.
Methods:
We performed a retrospective study of pediatric corneal grafts at L.V. Prasad Eye Institute, Hyderabad, India. Outcome of pediatric corneal transplantation was evaluated in terms of anatomic and optical success and factors contributing to poor graft survival. On the basis of the corneal pathology, patients were divided into three categories: congenital, acquired nontraumatic, and acquired traumatic.
Results:
A retrospective analysis of 154 penetrating keratoplasties performed in 140 children, aged 14 years or younger, was done. The average follow-up was 1.3 years (range, 1 week-5 years). Grafts remained clear in 102 (66.2%) of 154 eyes. Clear grafts were achieved in 30 (63.8%) of 47 eyes with congenital opacities, 12 (54.5%) of 22 eyes with opacities from trauma, and 60 (70.6%) of 85 eyes with acquired nontraumatic opacities. Most (26 of 52) of the graft failures occurred during the first 26 weeks after surgery. Survival analysis revealed the probability of a graft remaining clear at the end of 26 weeks as 80% (SE, 3.39%). Poor graft survival could be correlated with those younger than 5 years (p = 0.0341) and performance of anterior vitrectomy (p = 0.0002). Most grafts failed because of allograft rejection (42.3%), infectious keratitis (26.9%), or secondary glaucoma (13.4%). Postoperatively, 53 eyes had > or =20/400 vision, 29 of which had > or =20/50. Vision could not be assessed in 33 eyes because of the young age.
Conclusion:
Whereas anatomic success of pediatric keratoplasty is increasing, optical success continues to remain less than satisfactory. Early surgical intervention and intensive amblyopia therapy may promote visual recovery.
