Primary pediatric keratoplasty: indications and outcomes

To evaluate patient characteristics, indications, and outcomes of pediatric keratoplasty, and to identify variables that may help predict poor surgical outcomes.

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.

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).

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.