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Published on: October 21, 2022
Clinical Analysis of Repeat Penetrating Keratoplasty in Children
Yajie Sun1, Qi Lin2, Peng Song1
1Department of Ophthalmology, Henan Provincial People's Hospital, Henan Eye Institute, Zhengzhou 450003, China.
Insights
Repeat penetrating keratoplasty (RPK) in children is most often indicated for vascularized corneal scars. Graft survival is low, with immune rejection being a primary cause of failure, especially in younger children.
Area of Science:
- Ophthalmology
- Corneal Surgery
- Pediatric Eye Care
Background:
- Repeat penetrating keratoplasty (RPK) is a complex procedure in pediatric patients.
- Understanding indications and risk factors for RPK graft failure is crucial for improving outcomes in children.
- Previous studies have not sufficiently detailed RPK outcomes specifically in the pediatric population.
Purpose of the Study:
- To analyze the primary indications for repeat penetrating keratoplasty (RPK) in children under 12 years old.
- To evaluate graft survival rates and identify risk factors associated with graft failure after RPK in pediatric patients.
- To assess the incidence and types of postoperative complications following RPK in children.
Main Methods:
- A retrospective case series analysis of 30 RPK procedures in 29 children younger than 12 years.
- Data collected included indications for RPK, postoperative complications, graft survival, and causes of graft failure.
- Cox proportional hazards regression was used to analyze variables associated with graft survival.
Main Results:
- The most frequent indication for RPK was a vascularized corneal scar (86.67%).
- Postoperative complications were common (90%), with immune rejection (46.67%) being the most prevalent.
- One-year graft survival was approximately 60%, with an overall survival rate of 30% at the last follow-up. Younger age (<60 months), corneal vascularization, and postoperative epithelial defects were significant risk factors for graft failure.
Conclusions:
- Vascularized corneal scars are the leading indication for RPK in pediatric patients.
- Immune rejection, particularly irreversible rejection, is the primary cause of regraft failure.
- Early surgical intervention in very young children (<60 months) and managing postoperative epithelial defects are critical for improving RPK graft survival.
Abstract:
(1) Background: To analyze the indications, graft survival, and graft failure-related risk factors of repeat penetrating keratoplasty (RPK) in children. (2) Methods: In this case series, children younger than 12 years who received RPK at Beijing Tongren Hospital were reviewed. The indications for RPK, postoperative complications, and graft survival were analyzed. The analysis of the potential variables associated with graft survival was performed using Cox proportional hazards regression. (3) Results: A total of 30 RPK eyes of 29 children were included in this study. The mean follow-up time was 26.98 ± 18.75 months. The most common indication for RPK was a vascularized corneal scar (86.67%). Postoperative complications occurred in 27 eyes (90%), including immune rejection (46.67%), epithelial defects (36.67%), and glaucoma (26.67%). About 60% of the regrafts remained clear one year after RPK, while the overall graft survival rate was 30% at the last visit. The most common cause of regraft failure was irreversible immune rejection (8/21). The significant risks of graft failure included an age of less than 60 months at surgery (p = 0.009), corneal vascularization (p = 0.018), and a postoperative epithelial defect (p = 0.037). (4) Conclusions: A vascularized corneal scar is the most common indication of RPK in children. Immune rejection is the most prevalent complication, and irreversible immune rejection always causes regraft failure.
