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Long-Term Outcomes of Pediatric Keratoplasty at a Tertiary Care Center
Shivani P Majmudar1, Priyanka Chhadva2, Elmer Y Tu1
1Department of Ophthalmology, Illinois Eye and Ear Infirmary, University of Illinois, Chicago, IL; and.
Insights
Pediatric keratoplasty shows high graft failure rates but can restore ambulatory vision in over 60% of children. Outcomes improve for non-Hispanic White patients and when surgery is performed alone.
Area of Science:
- Ophthalmology
- Pediatric Surgery
- Transplantation Science
Background:
- Corneal opacity in children necessitates keratoplasty (corneal transplant) for visual rehabilitation.
- Pediatric keratoplasty presents unique challenges compared to adult procedures, including graft survival and visual outcomes.
- Understanding risk factors and long-term results is crucial for optimizing pediatric corneal transplantation.
Purpose of the Study:
- To analyze the indications for primary pediatric keratoplasty.
- To evaluate postoperative visual results and long-term graft survival.
- To identify factors influencing graft success in pediatric corneal transplantation.
Main Methods:
- Retrospective review of pediatric patients (≤16 years) undergoing keratoplasty for corneal opacity.
- Analysis of surgical indications, visual outcomes, and graft survival rates.
- Statistical analysis, including Cox proportional hazards regression, to identify risk factors for graft failure.
Main Results:
- Seventy-three eyes of 46 pediatric patients were analyzed with a mean follow-up of 5.82 years.
- Graft failure occurred in 56% of eyes, with significant risk factors including Black or mixed/other ethnicity and combined procedures.
- Ambulatory vision (≥20/800) was achieved in 64% of patients; younger age (<5 years) correlated with better outcomes in congenital cases.
Conclusions:
- Pediatric keratoplasty has a substantial graft failure rate but offers potential for ambulatory vision.
- Outcomes are more favorable in non-Hispanic White patients and when keratoplasty is the sole surgical intervention.
- Early transplantation for congenital corneal conditions enhances visual rehabilitation prospects.
Purpose:
To report the indications, postoperative visual outcomes, and long-term graft survival of primary pediatric keratoplasties performed at a single tertiary care center.
Methods:
We conducted a retrospective review of pediatric patients (16 years and younger) who underwent surgical intervention for corneal opacity at a tertiary care center to evaluate long-term graft survival and visual rehabilitation.
Results:
Seventy-three eyes of 46 patients met inclusion criteria. The mean patient age at the time of transplantation was 7.44 years (range, 5 months-15.72 years), and the average follow-up time was 5.82 years. Forty eyes (56%) had graft failure occurring at a mean time of 16.33 months (range, 27 days-12.58 years), of which 25 eyes (62.5%) underwent repeat keratoplasty. Cumulative graft survival probabilities at 1, 3, 5, and 7 years after keratoplasty were 60%, 55%, 44%, and 44%, respectively. Cox proportional hazards regression analysis showed Black ethnicity [hazard ratio (HR) = 4.72; confidence interval (CI), 1.16-19.23], mixed/other ethnicity (HR = 6.67, CI, 1.58-28.16), and keratoplasty in combination with another procedure (HR = 2.88; CI, 1.35-6.15) as significant risk factors of graft failure. 47 eyes (64%) achieved ambulatory vision (20/800 or better) at the last follow-up. Age younger than 5 years at time of keratoplasty was associated with better visual outcomes in patients with congenital disease ( P = 0.0017).
Conclusions:
Pediatric keratoplasty has a high rate of graft failure but can achieve ambulatory vision in >60% of patients. Keratoplasty outcomes are improved in non-Hispanic, White patients and when the intervention is performed alone. Younger age at time of keratoplasty for congenital conditions improves the likelihood of overall visual rehabilitation.
