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Penetrating keratoplasty in infants and children
1Kresge Eye Institute, Wayne State University, Detroit, MI 48201.
Insights
This study on pediatric penetrating keratoplasty found that acquired corneal scars and older children had better outcomes. Infants with multiple ocular anomalies and combined procedures had poorer graft survival rates.
Area of Science:
- Ophthalmology
- Pediatric Surgery
Background:
- Penetrating keratoplasty (PKP) is a complex procedure in pediatric patients.
- Outcomes in pediatric PKP can be influenced by various factors, including underlying ocular conditions and patient age.
Purpose of the Study:
- To evaluate the outcomes of penetrating keratoplasty in a pediatric cohort.
- To identify factors associated with successful graft survival and failure in children.
Main Methods:
- Retrospective analysis of 66 penetrating keratoplasties performed on 50 children (2 months to 14 years).
- Categorization of indications included congenital corneal opacification, corneal decompensation, keratoconus with hydrops, and failed grafts.
- Analysis of graft survival rates and prognostic factors.
Main Results:
- 32 grafts remained clear at 1-10 year follow-up; 30 grafts failed, and 4 eyes were lost.
- Favorable prognostic factors included acquired corneal scars, corneal decompensation, older children, and phakic eyes.
- Unfavorable prognostic factors included corneal perforations, active inflammation/infection, and infants with multiple ocular anomalies.
Conclusions:
- Pediatric penetrating keratoplasty outcomes vary significantly based on indication and patient-specific factors.
- Prognosis is generally poorer in infants with complex anomalies and those requiring combined surgical procedures.
Abstract:
Fifty children, 2 months to 14 years of age underwent 66 penetrating keratoplasties. Included were 18 eyes with congenital corneal opacification, 16 with corneal decompensation (either from congenital glaucoma, trauma, or multiple surgeries), 10 with corneal hydrops secondary to keratoconus, and 10 with failed grafts. There were 32 clear grafts with a 1- to 10-year follow-up, 30 failed grafts, and 4 lost eyes. Acquired corneal scars, corneal decompensation, older children, and phakic eyes had the best prognosis. Corneal perforations, active inflammation or infection, and infants with multiple ocular anomalies had the poorest prognosis. Children undergoing combined procedures did less well than those undergoing a single- or two-staged procedure.