Related Experiment Video
Updated: Sep 20, 2025
Full-Field Optical Coherence Microscopy for Histology-Like Analysis of Stromal Features in Corneal Grafts
Published on: October 21, 2022
Graft Failure After Pediatric Penetrating Keratoplasty in the United States
Isdin Oke1,2, Lyvia J Zhang1, Tobias Elze1
1Massachusetts Eye and Ear, Harvard Medical School, Boston, MA; and.
Insights
Pediatric corneal transplants have high failure rates. Approximately 50% of pediatric penetrating keratoplasty (PK) grafts failed within five years, with glaucoma and dry eye disease increasing risk.
Area of Science:
- Ophthalmology
- Transplantation Surgery
- Pediatric Medicine
Background:
- Corneal transplantation in children (pediatric penetrating keratoplasty or PK) has higher graft failure rates compared to adults.
- Understanding indications and outcomes is crucial for improving pediatric PK success.
Purpose of the Study:
- To analyze the indications for and outcomes of pediatric penetrating keratoplasty (PK).
- To identify factors associated with graft failure in pediatric corneal transplantation.
Main Methods:
- Retrospective cohort study of pediatric patients (≤18 years) undergoing PK from 2013-2020 using the IRIS Registry.
- Kaplan-Meier analysis estimated 5-year graft failure incidence.
- Multivariable Cox regression identified factors associated with graft failure.
Main Results:
- 544 children underwent PK, with nontraumatic acquired indications being most common (58%).
- The 5-year cumulative incidence of graft failure was 50%.
- Graft failure was significantly associated with glaucoma (HR 1.46), dry eye disease (HR 1.86), and corneal neovascularization (HR 1.76).
Conclusions:
- Nearly half of pediatric corneal transplants fail within five years.
- Ocular comorbidities like glaucoma and dry eye disease are linked to increased graft failure.
- Addressing these conditions may help reduce pediatric PK failure rates.
Purpose:
In contrast to adult patients, corneal transplants performed in pediatric patients tend to fare poorly, with relatively higher graft failure rates. The purpose of this study was to analyze the indications and outcomes of pediatric patients undergoing penetrating keratoplasty (PK).
Methods:
This retrospective cohort study included children ≤18 years in the IRIS Registry (Intelligent Research in Sight) who underwent PK (January 1, 2013-December 31, 2020). Corneal graft failure was identified using International Classification of Diseases codes. The Kaplan-Meier estimated 5-year cumulative incidence of graft failure after PK. Hazard ratios (HR) derived from multivariable Cox regression models were used to evaluate the association of graft failure with sociodemographic and clinical factors.
Results:
Five hundred forty-four children underwent PK (median age 15 years; 43% [234] female). Indications for surgery included nontraumatic acquired (58%, N = 318), congenital (18%, N = 100), other (9.6%, N = 52), and traumatic acquired (8.6%, N = 47). The cumulative incidence of graft failure within 5 years of PK was 50% (95% confidence intervals [CI], 45%-56%). The incidences did not differ between patients in various etiology groups. Graft failure was associated with glaucoma (HR, 1.46; 95% CI, 1.05-2.01; P = 0.023), dry eye disease (HR, 1.86; 95% CI, 1.18-2.92; P = 0.007), and corneal neovascularization (HR, 1.76; 95% CI, 1.00-3.08; P = 0.050).
Conclusions:
Approximately half of children undergoing PK in the IRIS Registry experienced graft failure within 5 years of transplantation. The association of graft failure with ocular conditions such as glaucoma and dry eye disease suggests potential avenues to decrease the high incidence of graft failure in this population.
