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[Penetrating keratoplasty in Down's syndrome]
Martin Bodenmueller1, David Goldblum, Beatrice E Frueh
1Department of Ophthalmology, University of Bern, Inselspital, Bern, Switzerland. bodenmuellermartin@bluemail.ch
Klinische Monatsblatter Fur Augenheilkunde
|March 29, 2003
Summary
Penetrating keratoplasty (PK) outcomes are poorer in Down's syndrome patients due to complications like graft rejection and glaucoma. Restrictive indications and considering deep lamellar keratoplasty may improve results for these patients.
Area of Science:
- Ophthalmology
- Genetics
- Corneal Surgery
Background:
- Down syndrome is a genetic disorder associated with various health issues, including ocular complications.
- Keratoconus is a progressive thinning of the cornea, often requiring corneal transplantation.
Purpose of the Study:
- To retrospectively analyze the outcomes and complications of penetrating keratoplasty (PK) in patients with Down syndrome.
- To compare the results with age-matched control patients with keratoconus.
Main Methods:
- Retrospective review of medical records for patients with Down syndrome who underwent PK since 1985.
- Data collected included patient demographics, indications for surgery, surgical techniques, complications, and visual acuity outcomes.
- Comparison with a control group of non-retarded patients with keratoconus who underwent PK.
Main Results:
- Of 16 eyes in 9 Down syndrome patients with keratoconus, 5 grafts remained clear post-surgery.
- High rates of re-PK (7 eyes), graft rejection (7 eyes), and conjunctival grafting for non-healing defects (4 eyes) were observed.
- Complications included cataracts (10 eyes) and secondary glaucoma (3 eyes). Control group had 22/25 clear grafts.
Conclusions:
- Penetrating keratoplasty prognosis is worse in Down syndrome patients compared to other keratoconus patients.
- Factors contributing to poor outcomes include emergency procedures, lid anomalies, advanced keratoconus, and patient cooperation.
- Restrictive indications for PK in Down syndrome patients with keratoconus and floppy eyelids are advised; deep lamellar keratoplasty may reduce complications.