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Updated: Jan 1, 2026
Murine Corneal Transplantation: A Model to Study the Most Common Form of Solid Organ Transplantation
Published on: November 17, 2014
Primary Pediatric Keratoplasty: Etiology, Graft Survival, and Visual Outcome
Maria Emilia Xavier Dos Santos Araújo1, Namir Clementino Santos1, Luciene Barbosa de Souza1
1Department of Ophthalmology and Visual Sciences, Paulista School of Medicine, São Paulo Hospital, Federal University of São Paulo - UNIFESP, São Paulo, Brazil.
Insights
Corneal transplantation in children, primarily for congenital glaucoma, shows improved visual acuity despite a 64.7% graft survival rate over 24 months. Graft failure is linked to rejection and early glaucoma.
Area of Science:
- Ophthalmology
- Pediatric Surgery
Background:
- Corneal transplantation in pediatric patients presents unique challenges.
- Understanding risk factors for graft failure is crucial for improving outcomes.
Purpose of the Study:
- To evaluate the causes, visual results, and survival rates of corneal transplantation in children.
- To identify risk factors associated with corneal graft failure in pediatric recipients.
Main Methods:
- A retrospective review of medical records for children aged 7 years or younger undergoing primary penetrating keratoplasty.
- Assessment of indications, graft survival using Kaplan-Meier analysis, and visual acuity (VA) improvement via preferential looking test and visual evoked potential.
Main Results:
- Fifty-six transplants were performed in 43 children, with congenital glaucoma as the primary indication (29.4%).
- Overall graft survival was 64.7% at 24 months post-transplant, with no significant difference between congenital and acquired opacity groups.
- Significant visual acuity improvement was observed in both congenital and acquired groups (P = .0022 and P < .0001, respectively).
Conclusions:
- Congenital glaucoma is a leading indication for pediatric corneal transplantation.
- Despite challenges, corneal transplantation in children can achieve prolonged graft survival and improved vision.
- Graft rejection and early-onset glaucoma are significant risk factors for corneal graft failure in pediatric patients.
Purpose:
Interventional study to evaluate the etiology, visual outcome and survival of corneal transplantation in children and to identify the risk factors associated with graft failure.
Design:
Retrospective, interventional consecutive case series.
Methods:
Medical records of every child 7 years of age or younger who underwent primary penetrating keratoplasty at Department of Ophthalmology, Federal University of São Paulo were reviewed. The parameters evaluated were indications for keratoplasty, graft survival, and postoperative visual acuity (VA) improvement. Children underwent ophthalmologic examination before and after corneal graft, including VA, assessed by the preferential looking test and visual evoked potential. The analysis of transplant survival was performed using the Kaplan-Meier method.
Results:
Fifty-six penetrating transplants were performed in 51 eyes of 43 children. The patients were divided into 2 groups: congenital (72.5%) and acquired (17.5%) corneal opacity. The main indication was congenital glaucoma (29.4%). The overall Kaplan-Meier graft survival rates were 64.7% in the postoperative average follow-up period of 24 months. There was no significant difference in graft survival between the congenital and acquired groups (Mantel-Cox P = .1031). There was significant improvement in VA in both groups (P = .0022 for congenital and P < .0001 for acquired). Rejection and diagnosis of congenital glaucoma were risk factors for graft failure.
Conclusions:
Congenital glaucoma was the main indication for corneal transplantation and despite the difficulties, prolonged survival and improved VA can be achieved in pediatric transplant. Complications such as rejection and early glaucoma were significantly associated with graft failure.
