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Published on: October 21, 2022
Indications and outcomes of pediatric penetrating keratoplasty: A retrospective observational study
Areen Abukahel1, Ahmad S Aldiwanie1, Saif Aldeen AlRyalat1
1Department of Ophthalmology, Jordan University Hospital, The University of Jordan, Amman, Jordan.
Insights
Pediatric penetrating keratoplasty (PKP) in Jordan significantly improved visual acuity in most young patients. The study highlights a high 1-year graft survival rate for pediatric corneal transplants.
Area of Science:
- Ophthalmology
- Transplantation Surgery
- Pediatric Medicine
Background:
- Pediatric corneal transplantation addresses congenital and acquired eye conditions.
- Challenges include complex pre-operative, intra-operative, and post-operative management.
- This study focuses on pediatric penetrating keratoplasty (PKP) in Jordan.
Purpose of the Study:
- To identify indications for pediatric PKP in Jordan.
- To evaluate the clinical outcomes of pediatric PKP.
- To assess visual acuity and graft survival rates.
Main Methods:
- Retrospective cohort study of patients under 18 years old.
- Reviewed 149 PKP cases from January 2004 to October 2019.
- Assessed pre-operative and 1-year post-operative best-corrected distance visual acuity (BCDVA) and graft survival.
Main Results:
- Acquired non-traumatic corneal pathologies were the primary indication (65.8%), with advanced keratoconus most frequent (55.7%).
- Significant improvement in BCDVA was observed (P < 0.001), with 74.5% of patients showing better vision.
- The 1-year graft survival rate was 80.54%.
Conclusions:
- Pediatric PKP in Jordan demonstrated significant visual improvement and a high 1-year graft survival rate.
- This study represents the largest cohort of pediatric PKP in Jordan.
- Further research with longer follow-up and assessment of lamellar keratoplasty is recommended.
Background:
Pediatric corneal transplantation can be indicated in congenital and acquired conditions. Challenges include preoperative evaluation, multiple intraoperative obstacles, and postoperative problems in follow-up and management. This study was aimed at identifying the indications and clinical outcomes of pediatric penetrating keratoplasty (PKP) in Jordan.
Methods:
This retrospective cohort study was conducted in Amman, Jordan. Using the hospital's electronic database, all medical records of patients aged < 18 years who underwent PKP between January 2004 and October 2019 were reviewed. Preoperative evaluations included best-corrected distance visual acuity (BCDVA) and anterior and posterior segment examinations. Postoperative complications, BCDVA, and graft survival were examined 1 year postoperatively.
Results:
A total of 149 cases of pediatric PKP were performed on 141 eyes of 118 patients with an age mean ± standard deviation (SD) of 11.44 ± 4.97 years at the time of surgery. Acquired non-traumatic corneal pathologies accounted for 65.8% of indications for PKP. The most frequent indication was advanced keratoconus (55.7%). Preoperative and 1-year postoperative BCDVAs significantly differed (P < 0.001), with 111 (74.5%) patients showing improved BCDVA, 12 (8.05%) patients showing worsened BCDVA, and 26 (17.45%) patients showing no change in BCDVA. The overall 1-year graft survival rate was 80.54%.
Conclusions:
This was the largest study in Jordan involving pediatric patients who underwent PKP for various indications, showing a significant improvement in BCDVA, with a high survival rate at 1 year. Future studies with longer follow-up periods could provide stronger evidence for surgical outcomes and graft survival. Further, the option of lamellar keratoplasty in the pediatric age group should be assessed.
