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Pediatric Penetrating Keratoplasty: Indications and Outcomes

https://doi.org/10.1016/j.transproceed.2011.01.055Get rights and content

Abstract

Purpose

This report evaluates patient characteristics, indications, and outcomes of pediatric keratoplasty, and identifies variables that help to predict poor surgical outcomes.

Methods

We undertook a retrospective review of all cases in our department of primary penetrating keratoplasty performed in children 14 years of age or younger between January 2003 and December 2009.

Results

Sixteen primary penetrating keratoplasties were performed during the study interval. Mean age was 11.2 years (3 to 14 years) and the gender ratio was 2. The mean duration of follow-up was 16 months (2 to 36 months).The surgical indications were acquired traumatic opacities in 6 cases, keratoconus in 5 cases, corneal perforation secondary to infectious keratitis in 3 cases, hereditary corneal dystrophy in 1 case, and acquired non-traumatic opacities secondary to congenital glaucoma in one case. The initial visual acuity was less than 1/20 in 68% of cases and the mean final visual acuity after 1 year was 2/10. The graft was clear in 52% of cases after 1 year of follow-up. Postoperative complications were graft failure (24%), ocular inflammation (5%), and ocular trauma (19%).

Conclusion

Penetrating keratoplasty in children has been documented to have a higher rate of graft failure and a worse visual prognosis than adult keratoplasty. Poor prognosis outcomes were especially caused by noncooperation of parents and postoperative ocular trauma.

Section snippets

Methods

In this retrospective study, the records of 16 cases of pediatric penetrating keratoplasty (15 patients) were reviewed between January 2003 and December 2008. The patients underwent surgery in Hedi Rais Institute of Ophthalmology (Department B). By reviewing the patients' medical records, history, clinical examination results, clinical and pathological diagnoses, and outcomes of keratoplasty of each patient was gathered. Follow-up data were collected until 3 years postoperatively (mean

Results

A total of 16 eyes from 15 pediatric patients up to 14 years of age underwent penetrating keratoplasty and were enrolled in this 5-year study. The median age at surgery was 11.2 years. Patients' age ranged from 3 to 14 years. Both eyes were operated in one case. The gender distribution involved 67% (n = 10) boys and 33% (n = 5) girls.

The classification by Stulting et al1 was used to group the participants into nontraumatic, acquired traumatic, and congenital indications. The acquired

Discussion

The cornea in children is more flexible and less rigid than in adults. Examinations before and after operation, medical treatments, and nursing procedures are all more difficult in children than in adults. Because of the anatomical and physical characteristics of a child's sclera, the crimpling of the eyeball during operation, forward displacement of the lens and iris diaphragm, as well as synechia, often occur in pediatric keratoplasty. The majority of infants and young children are hyperopic,

Conclusion

Our series shows that prolonged corneal graft survival can be achieved in childhood among patients grafted for either congenital or acquired causes of corneal opacity. Amblyopia and postoperative astigmatism were thought to be responsible for poor vision in the majority of clear grafts. Intensive amblyopic therapy may promote visual recovery.

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