Related Experiment Video
Updated: Jun 17, 2025
Iris Fixation via External Pentagram Suturing
Published on: May 5, 2022
Complications After Pediatric Penetrating Keratoplasty: An IRIS Registry Study
Lyvia J Zhang1, Reza Dana1, Alice C Lorch1
1Massachusetts Eye and Ear, Harvard Medical School, Boston, MA; and.
Insights
Postoperative complications occurred in nearly half of pediatric penetrating keratoplasty (PK) patients. Infectious keratitis was the most frequent complication, primarily affecting the anterior segment of the eye.
Area of Science:
- Ophthalmology
- Pediatric Surgery
- Corneal Transplantation
Background:
- Pediatric penetrating keratoplasty (PK) is a complex procedure.
- Understanding postoperative complication rates is crucial for patient outcomes.
Purpose of the Study:
- To determine the incidence of postoperative complications in children undergoing primary PK.
- To categorize complications by ocular segment (anterior vs. posterior).
Main Methods:
- Retrospective cohort study using the IRIS Registry (2013-2020).
- Included pediatric patients (0-18 years) undergoing primary PK.
- Complications identified via ICD-9/10 codes and categorized.
Main Results:
- 47.6% of 544 pediatric PK patients experienced complications.
- Anterior segment complications (40.8%) were more frequent than posterior (17.6%).
- Infectious keratitis was the most common anterior complication (30.0%); vitreous hemorrhage (9.6%) and retinal detachment (8.8%) were most common posterior complications.
Conclusions:
- Infectious keratitis is the leading postoperative complication in pediatric PK.
- Anterior segment complications are more prevalent than posterior segment complications.
- Findings highlight challenges in pediatric PK and inform management strategies.
Purpose:
To describe the frequency of postoperative complications in children undergoing penetrating keratoplasty (PK).
Methods:
This retrospective cohort study included pediatric patients (aged 0-18 years) in the Intelligent Research in Sight (IRIS) Registry who underwent primary PK between January 2013 and December 2020. Patients were identified using Current Procedure Terminology codes. Postoperative complications were identified using International Classification of Diseases Revision 9 and 10 codes and categorized as complications affecting the anterior segment (epithelial defect, infectious keratitis, neurotrophic keratitis, and glaucoma) or posterior segment (vitreous hemorrhage, retinal detachment, choroid detachment, choroidal hemorrhage, endophthalmitis, epiretinal membrane, and proliferative vitreoretinopathy).
Results:
Of the 544 pediatric patients undergoing PK, 259 (47.6%) experienced postoperative complications. Anterior segment complications (n = 222, 40.8%) were more common than posterior segment complications (n = 96, 17.6%). The most common anterior complication was infectious keratitis (n = 163, 30.0%) with a median onset time of 275 days (IQR 50-560 days) after surgery. Vitreous hemorrhage (n = 52, 9.6%) and retinal detachment (n = 48, 8.8%) were the most common posterior segment complications.
Conclusions:
Infectious keratitis was the most common postoperative complication in children undergoing PK. More complications occurred in the anterior segment (70%) of the eye as compared with the posterior segment (30%). These findings demonstrate the challenges associated with pediatric PK and may help guide postoperative monitoring and management.
