Related Experiment Video
Updated: Mar 15, 2026
Murine Corneal Transplantation: A Model to Study the Most Common Form of Solid Organ Transplantation
Published on: November 17, 2014
Survival of Primary Penetrating Keratoplasty in Children
Remzi Karadag1, Tommy C Y Chan2, Amir A Azari3
1Department of Ophthalmology, School of Medicine, Istanbul Medeniyet University, Istanbul, Turkey; Cornea Service, Wills Eye Hospital, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania.
Insights
Pediatric penetrating keratoplasty for congenital opacity offers good graft survival, with 75.7% at 1 year. Glaucoma and concurrent surgery negatively impact outcomes in children needing corneal transplants.
Area of Science:
- Ophthalmology
- Pediatric Surgery
- Corneal Transplantation
Background:
- Pediatric penetrating keratoplasty is a complex procedure for vision restoration in children.
- Congenital corneal opacity is a primary indication for corneal transplantation in the pediatric population.
- Graft survival rates and prognostic factors in pediatric corneal transplants require further investigation.
Purpose of the Study:
- To evaluate the indications and outcomes of primary penetrating keratoplasty in children.
- To identify factors influencing the survival of corneal grafts in pediatric patients.
- To assess the visual acuity achieved after pediatric corneal transplantation.
Main Methods:
- A retrospective, interventional case series design was employed.
- Medical records of children aged 12 years or younger undergoing primary penetrating keratoplasty between 2007 and 2015 were analyzed.
- Kaplan-Meier survival analysis and Cox proportional hazards regression were used to determine graft survival and prognostic factors.
Main Results:
- Forty-six eyes of 35 children underwent primary keratoplasty, with congenital opacity being the most common indication (89.1%).
- The overall 1-year graft survival rate was 75.7%. Graft survival was significantly lower in eyes with glaucoma (51.9%) compared to those without (90.7%).
- Glaucoma and concurrent operations were independent predictors of poor graft survival, while age at transplantation and prior/subsequent surgeries were not significant factors.
Conclusions:
- Pediatric penetrating keratoplasty can achieve successful outcomes with good graft survival despite its challenges.
- Identifying prognostic factors, such as the presence of glaucoma, is crucial for improving graft survival rates.
- Further understanding of these factors may lead to enhanced strategies for pediatric corneal transplantation.
Purpose:
To review the indications and outcomes of children undergoing primary penetrating keratoplasty and identify prognostic factors for graft survival.
Design:
Retrospective, interventional case series.
Methods:
Medical records of every child 12 years of age or younger who underwent primary penetrating keratoplasty at Wills Eye Hospital Cornea Service between 2007 and 2015 were reviewed. Survival of the primary graft was analyzed using the Kaplan-Meier survival method.
Results:
Forty-six eyes of 35 children underwent primary keratoplasty during the study period. The mean age at the time of primary keratoplasty was 24.6 ± 39.9 months. The mean follow-up duration was 36.4 ± 28.8 months. Congenital opacity was the most common diagnosis for primary keratoplasty (89.1%). The overall mean graft survival time was 45.2 ± 5.8 months, with a survival rate of 75.7% at 1 year. The 1-year graft survival rate was 51.9% and 90.7% in eyes with and without glaucoma, respectively. Cox proportional hazards regression analysis demonstrated that the presence of glaucoma (P = .014) and concurrent operation during primary keratoplasty (P = .049) were independent prognostic factors for poor graft survival. On the other hand, age of primary keratoplasty (P = .626) and operation before or after primary keratoplasty (P = .800 and P = .104, respectively) were not associated with poorer graft survival. Half of our patients were able to achieve ambulatory vision at the last follow-up.
Conclusion:
Although pediatric penetrating keratoplasty is challenging, successful transplantation with good graft survival can be obtained. Better understanding of prognostic factors can possibly improve graft survival in the future.
