Indications and outcomes of pediatric keratoplasty in a tertiary eye care center

Abstract

To evaluate indications and outcomes of pediatric keratoplasty in a tertiary eye center, and identify factors that affect visual outcomes.We performed a retrospective review of penetrating keratoplasty in children aged 0 to 18 years between 1995 and 2011 in the Asociación para Evitar la Ceguera en México IAP, Hospital “Dr. Luis Sánchez Bulnes”.A total of 574 penetrating keratoplasties were performed during the study interval. Median follow-up was 5.0 years. Main indications included keratoconus (55.58%), postherpetic scarring (9.58%), traumatic opacities (7.49%), and bullous keratopathy (6.09%). Rejection rates at 5 years were 27% overall, and among indications, keratoconus showed the best graft survival at 60-months follow-up (85%). The percentage of patients with best corrected visual acuity (BCVA) posttransplant >20/400 at 5 years in the nonrejection group was 81.25% and 82.74% in < and > 10 years of age (YOA) groups, respectively, versus a BCVA posttransplant > 20/400 at 5 years in the rejection group of 53.68% and 51.72% in < and > 10 YOA groups, respectively. There was a statistically significant reduced rejection rate between genders at 18 months of follow-up, favoring males.Despite being considered a high-risk procedure in children, penetrating keratoplasty can achieve good results, especially in patients with keratoconus. It can achieve significative improvements of visual acuity, provided there is an adequate follow-up and treatment adherence.

Factors Associated With Graft Rejection in the Cornea Preservation Time Study

“…A higher risk for rejection of penetrating grafts has been well recognized in the pediatric population. 44 To our knowledge this is the first report that among recipients older than 50 years old, graft rejection following DSAEK is more likely in younger recipients, as has been noted with high rejection risk PKP cases. 27 This may be the result of the immune system becoming less active with increasing age, 45…”

Development of a Nomogram to Predict Graft Survival After Penetrating Keratoplasty

“…36 The higher prevalence of Peters' anomaly with associated cataract and glaucoma could explain some of the relationship between pediatric PKs and graft failure. Another possible explanation for poorer graft outcomes in children is the more robust immune response in younger individuals, 37 which could lead to a higher risk of graft rejection compared to adults. We performed an additional analysis of graft survival comparing patients ≤10 years old and > 10 years old at the time of PK, which revealed that the younger age group had a 1.81 greater probability of graft failure as compared to the older age group ( P = .008).…”

Pediatric keratoconus - Current perspectives and clinical challenges

“…[ 89 ] Gulias-Cañizo et al found in their recent retrospective review of a large series of 574 pediatric keratoplasties, KC showed the best graft survival at 60-months follow-up of 85%, as compared to other indications. [ 93 ] The Australian Registry Study on corneal transplantation in KC in all age groups observed significantly better outcomes with the first PK for KC to have a significantly better survival of 89% at 10 years in comparison to 49% at 20 years. [ 92 ]…”

“…The addition of topical cyclosporine can help reduce the long-term corticosteroid use required to alleviate graft rejection in children. [ 97 ] The Urret–Zavalia syndrome can occur, especially after DALK, with the prolonged anterior chamber filling with a tight air bubble, as with cases of long drawn of anterior lamellar dissection as in BB-DALK[ 93 ] or after tight pneumopexy for DM perforation. [ 82 ] Though the exact pathogenesis is not clear, pressure-induced ischemic necrosis is postulated to cause dilated and fixed pupil, iris atrophy, and even cataract.…”