[Penetrating keratoplasty for keratoconus in trisomy 21]

Between 1982 and 1990, penetrating keratoplasties for keratoconus were performed in 9 eyes of 7 patients (age 17-41 years) with Down's syndrome. All eyes showed dense scarring of the central cornea. Follow-up was 10-49 months (mean 28 months). Preoperative corrected visual acuity was hand movements to 20/400. Complications were suture loosening in one eye and leukocytic infiltration of a suture track in one eye, both responded well to therapy. Graft rejection, intraocular infection, wound dehiscence and secondary glaucomas were not observed. The postoperative visual acuity improved in all eyes, ranging from 20/200 to 20/100. If indication to surgery is made carefully and if adequate postoperative care and frequent follow-up examinations are provided, the prognosis of penetrating keratoplasty in patients with Down's syndrome seems to be good and keratoplasty should be considered in patients with dense corneal scars.