Keratoplasty in patients with intellectual disability

The aim was to report the outcome of keratoplasty in patients with intellectual disability (ID).

All patients with ID who had undergone keratoplasty at the Eye Department, Red Cross Hospital, Munich, between January 1, 1991, and December 31, 2010, were identified and recalled for examination. In cases of missing data, the information contained in the patient's chart was analyzed and/or his ophthalmologist was contacted.

A total of 38 eyes (29 patients) that had undergone 53 keratoplasty procedures were included in the analysis. In 20 patients, the general diagnosis was Down syndrome, 1 patient had ID as a result of brain tumor excision, and 8 patients had ID of an unknown origin. The indication for the primary keratoplasty (n = 35) was keratoconus in 33 patients and corneal opacity because of exposure in facial nerve palsy in 2 patients. In the 3 remaining patients, the first procedure at the study institution was a repeat keratoplasty. The median follow-up was 9 years (minimum 6 months, maximum 20 years). The graft survival rate of the primary graft was 86% (n = 30/35) from 27 months to 11 years. At the last follow-up visit, a clear graft was present in 89% of all the patients (n = 34/38). One eye underwent enucleation, and 3 other eyes remained with a cloudy graft after multiple interventions for rejection/corneal ulceration.

The majority of the patients with ID clearly benefited from keratoplasty, although a few deleterious courses occurred. Keratoplasty in these individuals can be considered whenever patients can no longer comply with the visual demands of their particular individual life.