Related Experiment Video
Updated: Mar 7, 2026
Surgical Correction for Pediatric Epiblepharon and Trichiasis
Published on: July 8, 2025
[Keratoplasty in Children and Adolescents]
Insights
Pediatric penetrating keratoplasty outcomes vary by indication and age. Infants have poor graft survival, while keratoconus offers the best prognosis for corneal transplants in children.
Area of Science:
- Ophthalmology
- Pediatric Surgery
- Corneal Transplantation
Background:
- Long-term graft survival in pediatric corneal transplantation is challenging due to immunological differences, clinical examination difficulties, and reduced patient compliance.
- Penetrating keratoplasty is often the sole viable option for preventing amblyopia in children, despite unfavorable conditions.
- This study investigates indications, graft survival rates, and complications in pediatric corneal transplants across two specialized centers.
Purpose of the Study:
- To analyze the indications for penetrating keratoplasty in patients under 18 years of age.
- To evaluate graft survival rates and identify factors influencing outcomes in pediatric corneal transplants.
- To assess the incidence of complications, including graft failure and enucleation, in this patient cohort.
Main Methods:
- Retrospective review of electronic medical records for all patients under 18 undergoing penetrating keratoplasty.
- Data collection included surgical indications, graft failure events, visual acuity measurements, and occurrences of enucleation.
- Kaplan-Meier survival analysis was employed to estimate graft survival rates based on indications and patient age.
Main Results:
- A total of 104 eyes from 95 pediatric patients were analyzed, with a median age of 14 years at surgery and a median follow-up of 2.7 years.
- Key indications included keratoconus (39%), penetrating injuries (18%), and corneal scars (non-herpetic 12%, herpetic 6%).
- Graft survival varied significantly by indication, ranging from 100% for keratoconus to 35% for sclerocornea. Infants showed complete graft failure within one year, while older children maintained 90% graft clarity at one year.
Conclusions:
- The prognosis for penetrating keratoplasty in children is strongly influenced by the underlying indication and the patient's age.
- Infants demonstrate a particularly poor prognosis with very limited clear graft survival.
- Keratoconus presents the most favorable indication for pediatric corneal transplantation, whereas sclerocornea and penetrating injuries carry the highest risk of graft failure.
Background:
The conditions for long-term graft survival in infants and children are unfavorable, due to the different immunological features, the impaired clinical examination and the reduced compliance and treatment adherence. However, penetrating keratoplasty is often the only option to prevent amblyopia and there may be no alternative. We examined the different indications, graft survival and complications in two specialised centres.
Material And Methods:
We identified all patients who were under the age of 18 years at the time of their penetrating keratoplasty. We then assessed the electronic file on indications, graft failure, visual acuity, enucleation and further complications.
Results:
A total of 104 eyes of 95 patients (54 % female) were identified. Median age at the time of surgery was 14 years (quartiles 8 and 16 years). Median follow-up was 2.7 years. The following indications were identified: keratoconus (39 %), penetrating injury (18 %), non-herpetic corneal scars (12 %), herpetic corneal scars (6 %), sclerocornea (3 %), chemical burn (3 %) and miscellaneous indications (19 %). Clear graft survival according to the Kaplan-Meier method ranged from 100 % (keratoconus) to 35 % (sclerocornea). Enucleation was only necessary in patients with penetrating injuries (n = 2). Kaplan-Meier analysis estimated the failure of all grafts after one year in infants. In older patients, 90 % of grafts were still clear at that time.
Conclusion:
Prognosis of penetrating keratoplasty in children is related to the indication, and therefore the underlying disease, as well as the patients' age. In particular, infants exhibited poor prognosis, with only a very short period of clear graft survival. In indications, keratoconus showed the best prognosis, whereas sclerocornea and penetrating injuries had the worst prognosis.
