Keratoplasty for Keratoconus in Young Patients: Demographics, Clinical Features, and Post-transplant Outcomes
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Denise Wajnsztajn1, Cathy L Hopkinson2, Daniel F P Larkin1
1From the Cornea & External Diseases Service, Moorfields Eye Hospital, London, United Kingdom (D.W., D.F.P.L.).
Insights
Pediatric corneal transplants for keratoconus show outcomes comparable to adults, with no benefit to delaying surgery. Younger patients achieve similar visual results and transplant survival rates, with rejection risk decreasing with age.
Area of Science:
- Ophthalmology
- Corneal Surgery
- Pediatric Eye Care
Background:
- Keratoconus is a progressive eye condition often requiring corneal transplantation.
- Outcomes of corneal transplantation in pediatric patients with keratoconus are less understood compared to adults.
- Understanding outcomes in young patients is crucial for guiding treatment decisions.
Purpose of the Study:
- To compare pretransplant findings and post-transplant outcomes of corneal transplantation for keratoconus in children versus adults.
- To evaluate the influence of demographic factors and transplant type on visual acuity, rejection, and graft survival.
- To determine if delaying corneal transplantation in pediatric keratoconus patients offers any advantages.
Main Methods:
- Retrospective cohort study using a UK national registry.
- Comparison of 170 pediatric patients (≤16 years) with 7,191 adult patients (≥17 years) undergoing their first corneal transplant for keratoconus (2003-2018).
- Analysis of demographic variables, pretransplant corneal findings, and transplant type on 2-year visual, rejection-free, and transplant survival outcomes.
Main Results:
- Children presented with poorer pretransplant visual acuity and higher rates of corneal vascularization and ocular surface disease.
- Two-year post-transplant corrected visual acuity (≥20/20) was achieved in 35% of children versus 28% of adults (P=0.1).
- Transplant rejection (11%) and failure (3%) rates in children were comparable to adults, with no irreversible rejection recorded in pediatric cases. Graft survival was similar for penetrating keratoplasty and anterior lamellar keratoplasty in children.
Conclusions:
- Pediatric corneal transplantation for keratoconus yields excellent visual results and outcomes comparable to adult patients.
- The risk of corneal graft rejection decreases with advancing age.
- There is no evidence to support delaying corneal transplantation in young keratoconus patients with poor vision until adulthood.
Purpose:
To examine pretransplant findings and outcomes of corneal transplants for keratoconus in children.
Design:
Retrospective cohort (national registry) study.
Methods:
Data on all patients aged 16 or younger (n = 170) who had a first transplant for keratoconus between 2003 and 2018 in all corneal transplant centers in the UK were compared to adult patients aged 17 and older (n = 7,191). The influence of demographic variables, pretransplant corneal findings, and transplant type on 2-year visual, rejection-free, and transplant survival outcomes was examined.
Results:
Children had poorer pretransplant visual acuity and higher rates of corneal vascularization and ocular surface disease than adults. However, 2-year post-transplant corrected visual acuity reached 20/20 or better in 35% of children compared to 28% of adults (P = .1). Transplant rejection and failure rates were 11% (P = .79) and 3% (P = .31), respectively, for children, which were comparable to rates for adults. Endothelial rejection was reported following penetrating keratoplasty (PK) in 13% of children (10% in adults). Irreversible rejection was not recorded for any transplant in a child. Despite a lack of difference in transplant outcomes, there was a significant age effect in the Cox regression model for transplant rejection, such that for every 5-year increase in age there was a 6% reduction in the hazard of rejection. Transplant survival following anterior lamellar keratoplasty and PK in children was similar.
Conclusions:
Young keratoconus patients have excellent transplant outcomes and visual results comparable to adults. Overall, the hazard of rejection was found to decrease with advancing age. However, in this large cohort of young patients with keratoconus and poor vision, there is no evidence of outcome advantage in delaying transplant until adult years.
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