[Penetrating keratoplasty for keratoconus in a case of Down's syndrome]

We report a Down's syndrome patient who underwent penetrating keratoplasty (PKP) surgery. The patient was a 62-year-old female who had Down's syndrome with severe bilateral keratokonus and cataract. Her visual acuity was very poor as she did everything by touch before the surgery. We performed a triple procedure surgery, i.e., PKP, extracapsular cataract extraction, and posterior chamber intraocular lens implantation in her left eye. After the surgery her visual behavior improved markedly. This case shows that PKP surgery can be performed on such handicapped patients who are difficult handle in emergencies and need general anesthesia, because we have been able to keep the donor cornea longer than usual. We conclude that we should actively perform the PKP surgery for the handicapped if the patient does not have self-damaging behavior and if there is cooperation of the family and the medical staff.