Outcome of penetrating keratoplasty for Peters anomaly

To determine the results of corneal graft survival after penetrating keratoplasty for Peters anomaly.

Retrospective review of records of children 12 years of age or younger who underwent penetrating keratoplasty for Peters anomaly between March 1988 and December 2003. The data were analyzed regarding graft survival. The survival probabilities were estimated by using the Kaplan-Meier method. The main outcome measure was graft clarity.

Forty corneal transplants were performed in 32 children with Peters anomaly whose mean age at keratoplasty was 8.6 +/- 3.9 months (range, 2.5-22 months). The mean follow-up period was 1.9 +/- 2.9 years (range, 1 month to 15 years). Seventeen (42.5%) of the 40 grafts retained full clarity. Survival analysis showed a 52% probability of the graft remaining clear at the end of 6 months, which dropped to 22% at 2 years. The predicted mean survival time of grafts was 20.1 months (95% confidence interval, 4.9-36.3). Allograft rejection was the most frequently identified cause of graft failure, accounting for 15 (65%) of the 23 failed grafts, with 93.3% of episodes occurring in the first year. Poor graft survival correlated with age younger than 6 months (P = 0.04).

The overall probability of maintaining a clear corneal transplant in Peters anomaly is 22% at 2 years and may be adversely affected by younger age at surgery. Because most episodes of rejection occurred in the first year, follow-up is recommended during this period.