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Published on: October 21, 2022
Primary pediatric keratoplasty: indications and outcomes
Charles Huang1, Mary O'Hara, Mark J Mannis
1Department of Ophthalmology & Vision Science, University of California, Davis, Sacramento, CA 95817, USA.
Insights
Pediatric penetrating keratoplasty offers a 50% graft survival rate at one year. Pre-existing or post-operative glaucoma significantly reduces long-term graft survival in these young patients.
Area of Science:
- Ophthalmology
- Pediatric Surgery
Background:
- Pediatric penetrating keratoplasty (PKP) is a complex procedure with variable outcomes.
- Understanding factors influencing graft survival is crucial for improving patient care.
Purpose of the Study:
- To analyze patient characteristics, indications, and outcomes of pediatric PKP.
- To identify predictors of poor surgical outcomes in pediatric corneal transplantation.
Main Methods:
- Retrospective chart review of 106 PKPs in children aged 14 years and younger (1991-2006).
- Statistical analysis focused on primary graft survival data.
- Median follow-up duration was 4.4 years.
Main Results:
- Overall 1-year graft survival was 54%.
- No significant difference in survival based on surgical indications (congenital, acquired nontraumatic, acquired traumatic opacities).
- Pre-existing or post-operative glaucoma was the only independent predictor of worse graft survival (32% vs. 70% at 1 year, P=0.02).
Conclusions:
- Pediatric PKP demonstrates a fair prognosis with approximately 50% graft survival at 1 year.
- Glaucoma significantly impacts long-term graft survival in pediatric corneal transplants.
Purpose:
To evaluate patient characteristics, indications, and outcomes of pediatric keratoplasty, and to identify variables that may help predict poor surgical outcomes.
Methods:
The authors performed a retrospective chart review of penetrating keratoplasty performed in children 14 years and younger between 1991 and 2006. Primary keratoplasty data were used in the statistical analysis for graft survival.
Results:
A total of 106 penetrating keratoplasties were performed in 47 patients during the study interval. Sixty procedures were primary grafts, and the remaining were regrafts. Median follow-up was 4.4 years. The surgical indications included congenital opacities in 37 eyes (61.6%), acquired nontraumatic opacities in 13 eyes (21.7%), and acquired traumatic opacities in 10 eyes (16.7%). Overall graft survival at 1 year was 54%. There was no statistically significant difference in 1 year graft survival among the surgical indication categories (congenital opacities 54%, acquired nontraumatic 53%, acquired traumatic 48%, P = 0.8). Graft survival at 1 year was similar among the different age groups (48% for patients younger than 6 months, 67% for patients 6 months to 5 years, 51% for patients older than 5 years, P = 0.78). Patients with Peters' anomaly had similar graft survival rates to patients with other congenital opacities (67% vs 48% survival at 1 year, P = 0.78) Patients with pretransplant and/or posttransplant glaucoma had worse 1-year graft survival compared with patients without preoperative glaucoma (glaucoma 32% vs no glaucoma 70%, P = 0.02) Pretransplant and/or posttransplant glaucoma was the only independent predictor of worse graft survival in a multivariate analysis (P = 0.02).
Conclusions:
Pediatric penetrating keratoplasty has a fair overall prognosis for graft survival of approximately 50% at 1 year. Prekeratoplasty and/or postkeratoplasty glaucoma is associated with poorer long-term graft survival.
