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Published on: September 17, 2014
Penetrating keratoplasty in infants
Insights
Early penetrating keratoplasty in infants with congenital corneal opacity shows a 61% graft survival rate at 12 months. Factors like Peter's anomaly increase failure risk, but careful management can improve visual outcomes.
Area of Science:
- Ophthalmology
- Pediatric Surgery
- Corneal Transplantation
Background:
- Congenital corneal opacity presents a significant challenge in pediatric eye care.
- Early intervention is crucial to prevent irreversible vision loss, such as deprivation amblyopia.
Purpose of the Study:
- To evaluate graft survival and visual outcomes following penetrating keratoplasty in infants diagnosed with congenital corneal opacity.
- To identify factors influencing the success of corneal transplantation in this pediatric population.
Main Methods:
- Retrospective analysis of 11 infants who underwent penetrating keratoplasty for congenital corneal opacity.
- Data collected included diagnoses (Peter's anomaly, congenital hereditary endothelial dystrophy, posterior polymorphous dystrophy, sclerocornea), surgical details, and graft outcomes.
Main Results:
- A total of 26 penetrating keratoplasties were performed on 16 eyes across 11 infants, with a median age of 13 weeks at first surgery.
- Overall 12-month graft survival was 61%, with 10 of 16 eyes retaining a clear graft.
- Peter's anomaly, lensectomy, and repeat grafts were associated with poorer graft survival and visual acuity.
Conclusions:
- Early penetrating keratoplasty is a viable option to prevent deprivation amblyopia in infants with congenital corneal opacity.
- Despite a high risk of graft failure, particularly in Peter's anomaly cases, careful patient selection and postoperative management can lead to successful visual results.
Purpose:
To analyze graft survival and visual outcome after penetrating keratoplasty in infants with congenital corneal opacity.
Methods:
We retrospectively reviewed the records of 11 patients with congenital corneal opacity who underwent penetrating keratoplasty as infants. Six patients had a diagnosis of Peter's anomaly, 1 of congenital hereditary endothelial dystrophy, 1 of posterior polymorphous dystrophy, and 2 of sclerocornea, and in the other patient, the cause of the opacity was unknown.
Results:
In total, 26 penetrating keratoplasties were performed on 16 eyes of 11 infants. All patients initially underwent surgery before the age of 13 months. Five patients underwent bilateral penetrating keratoplasty, and 10 of the transplants were repeat operations on eyes that had already had at least one previously failed graft. The age of the infants at the time of first penetrating keratoplasty ranged from 2 to 56 weeks (median, 13 weeks). The graft survival time for all transplants ranged from 3 to 137 months (median, 16 months). Overall first graft survival at 12 months was 61% (95% CI, 33%-81%), with 10 of 16 eyes retaining a clear corneal graft. Peter's anomaly, lensectomy, and repeat penetrating keratoplasty were factors most highly associated with poor graft survival and a low final visual acuity.
Conclusion:
Early penetrating keratoplasty for congenital corneal opacity may prevent deprivation amblyopia. Although this procedure carries a high risk of failure, particularly in those patients with Peter's anomaly, careful case selection, optical correction, and management of postoperative amblyopia may result in a successful visual outcome.
