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Full-Field Optical Coherence Microscopy for Histology-Like Analysis of Stromal Features in Corneal Grafts
Published on: October 21, 2022
Primary pediatric keratoplasty: indications, graft survival, and visual outcome
Ali Al-Ghamdi1, Ali Al-Rajhi, Michael D Wagoner
1Department of Ophthalmology, King Khaled Eye Specialist Hospital, Riyadh, Kingdom of Saudi Arabia.
Insights
Pediatric penetrating keratoplasty outcomes vary by cause. Congenital hereditary endothelial dystrophy (CHED) eyes show excellent graft survival and visual prognosis, unlike other pediatric corneal opacity cases.
Area of Science:
- Ophthalmology
- Pediatric Ophthalmology
- Corneal Surgery
Background:
- Pediatric penetrating keratoplasty has higher graft failure and worse visual prognosis than adult procedures.
- Understanding outcomes in pediatric corneal transplantation is crucial for improving patient care.
Purpose of the Study:
- To evaluate graft survival and visual prognosis in pediatric penetrating keratoplasty.
- To compare outcomes based on surgical indications, particularly congenital hereditary endothelial dystrophy (CHED).
Main Methods:
- Retrospective review of primary penetrating keratoplasty in children aged 12 or younger.
- Data collected from King Khaled Eye Specialist Hospital between 1990 and 2003.
- Analysis of surgical indications including congenital, traumatic, and non-traumatic acquired opacities.
Main Results:
- 165 primary penetrating keratoplasties were performed in 134 children.
- Congenital opacities were the primary indication (78.8%), with CHED accounting for 35 cases.
- Graft survival was significantly higher in eyes with CHED compared to other indications (p < 0.001), with better visual outcomes.
Conclusions:
- Pediatric keratoplasty shows an excellent prognosis for graft survival in CHED cases.
- A fair prognosis exists for non-CHED congenital and acquired opacities.
- CHED eyes achieve the best visual prognosis, while non-CHED congenital opacities have the worst.
Background:
Penetrating keratoplasty in children has been documented to have a higher rate of graft failure and a worse visual prognosis than adult keratoplasty.
Methods:
We undertook a retrospective review of all cases of primary penetrating keratoplasty performed in children 12 years of age or younger at the King Khaled Eye Specialist Hospital between January 1, 1990, and December 31, 2003.
Results:
One hundred sixty-five primary penetrating keratoplasties were performed in 134 children during the study interval. The surgical indications were congenital opacities in 130 eyes (78.8%), acquired, traumatic opacities in 18 eyes (10.9%), and acquired, nontraumatic opacities in 17 eyes (10.3%). Among congenital opacities, 35 cases were caused by congenital hereditary endothelial dystrophy (CHED). The median follow-up for 73 grafts (44.2%) that remained clear was 50 months (range, 12-50 months), whereas the median follow-up for 92 grafts (55.8%) that failed was 6 months (range, 1-54 months). Kaplan-Meier graft survival was significantly higher at all postoperative intervals in eyes with CHED than for other surgical indications (p < 0.001). Eyes with CHED were significantly more likely to achieve ambulatory vision or vision >20/200 than eyes with other indications (p < 0.001).
Conclusions:
Pediatric keratoplasty was associated with an excellent prognosis for graft survival in eyes with CHED and a fair prognosis for graft survival in eyes with non-CHED congenital opacities and acquired opacities. The best visual prognosis was obtained in eyes with CHED and the worst prognosis was for non-CHED congenital opacities.
