J Korean Ophthalmol Soc.  2013 May;54(5):704-708. 10.3341/jkos.2013.54.5.704.

Clinical Outcomes of Penetrating Keratoplasty in Patients Five Years or Younger

• Kim YW
• Choi HJ
• Kim MK
• Wee WR
• Yu YS
• Oh JY

• KMID: 2217034
• DOI: http://doi.org/10.3341/jkos.2013.54.5.704

Abstract

PURPOSE
To investigate the clinical outcomes of primary pediatric keratoplasty.
METHODS
Records of patients who underwent penetrating keratoplasty at the age of 5 years or younger were retrospectively reviewed. The survival rates of corneal grafts, postoperative complications, and causes of graft failure were evaluated.
RESULTS
A total of 31 penetrating keratoplasties were performed in 29 patients, two of which were bilateral. The mean follow-up period was 78.72 +/- 8.94 months. The overall graft survival rate was 51.61%. The graft survival rate was 77.4% at 6 months, 61.3% at 12 months, 57.5% at 2 years, and 49.5% at 5 years after the surgery (the median survival time, 39.2 months). The main surgical indications included sclerocornea (35.5%), followed by Peter's anomaly (25.8%) and congenital glaucoma (9.7%). There were significant differences in graft survival time among the surgical indications, of which sclerocornea was the worst (p = 0.003). The main cause of graft failure was rejection (46.7%), followed by infection (26.7%) and primary endothelial decompensation (20%). When patients were sub-grouped according to age (under 12 months, between 12 to 48 months, and over 48 months), there was significant difference in graft survival time (p = 0.037) but not in overall graft survival rate (p = 0.154). Graft rejection occurred more frequently in patients between 12 to 48 months of age compared to other age groups (p = 0.016). Three out of 13 graft infections occurred in patients under 12 months of age.
CONCLUSIONS
The type of disease causing corneal opacity was a significant factor affecting the clinical outcomes of penetrating keratoplasty in children.

Keyword

Graft survival time; Penetrating keratoplasty

MeSH Terms

Child
Cornea
Corneal Diseases
Corneal Opacity
Follow-Up Studies
Glaucoma
Graft Rejection
Graft Survival
Humans
Keratoplasty, Penetrating
Postoperative Complications
Rejection (Psychology)
Retrospective Studies
Survival Rate
Transplants
Cornea
Corneal Diseases

Figure

• 

  Figure 1. The Kaplan-Meier survival curve of corneal grafts. The overall graft survival rate was 51.6%. The graft survival was 77.4% at 6 months, 61.3% at 12 months, 57.5% at 2 years and 49.5% at 5 years after the surgery.

• 

  Figure 2. The Kaplan-Meier survival curve of corneal grafts according to the surgical indications. Corneal mass, CHED and Peter’s anomaly show favorable outcome whereas scle-rocornea, congenital glaucoma, acquired corneal opacities and aniridia showed poor outcome. The differences of median sur-vival time among the surgical indications reached statistical significance ( p = 0.003, Log-Rank test).

• 

  Figure 3. The Kaplan-Meier survival curve of corneal grafts according to the age groups. The mean survival time of cor-neal grafts according to the age groups was significantly dif-ferent; 72.26 ± 17.62 months in age under 12 months vs 54.03 ± 20.57 months in age 12 to 48 months vs 144.03 ±14.60 months in age over 48 months ( p = 0.037, Log-Rank test).

• 

  Figure 4. The Kaplan-Meier survival curve of corneal grafts according to the use of topical intraocular pressure (IOP) low-ering agents. The median survival time was not significantly different between the patients who used IOP lowering agents due to increased IOP after the surgery and those who did not ( p = 0.810, Log-Rank test).

Reference

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