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Graft rejection in pediatric penetrating keratoplasty: Clinical features and outcomes
Rakhi Kusumesh1, Murugesan Vanathi2
1Regional Institute of Ophthalmology, Indira Gandhi Institute of Medical Sciences, Patna, India.
Insights
Pediatric corneal graft rejection occurred in 12.1% of cases, with only 25% reversal due to delayed treatment. Irreversible rejection remains the primary cause of graft failure in pediatric penetrating keratoplasty (PK).
Area of Science:
- Ophthalmology
- Transplantation Surgery
- Pediatric Eye Care
Background:
- Early detection of corneal graft rejection is crucial for timely treatment and improved outcomes in pediatric patients.
- Understanding the incidence, clinical features, and outcomes of graft rejection in pediatric penetrating keratoplasty (PK) is essential for optimizing patient care.
Purpose of the Study:
- To analyze the incidence, clinical features, rejection-treatment period, and outcomes of corneal graft rejection in pediatric PK.
- To identify factors contributing to graft failure and low reversal rates in pediatric corneal transplantation.
Main Methods:
- Retrospective review of case records for pediatric PK surgeries performed in children under 12 years.
- Data collected included demographic profile, surgical indication, time to rejection, interval to treatment, graft outcome, and complications.
Main Results:
- PK was performed in 66 eyes; 8 eyes (12.12%) experienced graft rejection.
- The most common indication for surgery was scarring after keratitis (33.4%).
- The mean interval between surgery and rejection was 10.5 months, and between rejection and treatment was 10.9 days.
Conclusions:
- Irreversible graft rejection is the leading cause of graft failure in pediatric PK.
- The low reversal rate (25%) in this study is attributed to delayed presentation and treatment.
- Categorizing graft rejection types in pediatric patients presents significant challenges.
Purpose:
Early presentation of rejection facilitates early initiation of treatment which can favor a reversible rejection and better outcome. We analyzed the incidence, clinical features including rejection-treatment period and outcomes following graft rejection in our series of pediatric corneal graft.
Materials And Methods:
Case records of pediatric penetrating keratoplasty (PK) were reviewed retrospectively, and parameters noted demographic profile, indication of surgery, surgery-rejection period, rejection-treatment interval, graft outcome, and complications.
Results:
PK was performed in 66 eyes of 66 children <12 years, with an average follow-up of 21.12 ± 11.36 months (range 4-48 month). The median age at the time of surgery was 4.0 years (range 2 months to 12 years). Most of the children belonged to rural background. Scarring after keratitis (22, 33.4%) was the most common indication. Graft rejection occurred in eight eyes (12.12%) (acquired nontraumatic - 3, congenital hereditary endothelial dystrophy [CHED] - 2, nonCHED - 1, congenital glaucoma - 1, regraft - 1). The mean surgery-rejection period was 10.5 ± 7.3 months and mean rejection-treatment interval was 10.9 ± 7.02 days.
Conclusion:
This study showed irreversible graft rejection was the leading cause of graft failure of pediatric PK. Though, the incidence (12.1%) of graft rejection in current study was not high, but the percentage of reversal (25%) was one of the lowest in literature because of delayed presentation and longer interval between corneal graft rejection and treatment. In addition, categorization of the type of graft rejection was very difficult and cumbersome in pediatric patients.
