Indications, Clinical Outcomes, and Survival Rate of Pediatric Penetrating Keratoplasty in Suburban Malaysia: A 10-year Experience

Abstract

PurposeTo describe the demographics, indications, clinical outcomes and survival rate of penetrating keratoplasty in Malaysian children living in a suburban area, and discuss the literature on paediatric penetrating keratoplasty.MethodologyA retrospective review of medical records was performed on children younger than 17 years of age who had undergone penetrating keratoplasty in Hospital Universiti Sains Malaysia from January 2008 to December 2017. We recorded demographic data, presenting visual acuity, indications, final visual acuity, and graft survival at 12 months into the postoperative period.ResultsSixteen eyes of 14 children had penetrating keratoplasty. Mean age was 7.8 ± 5.9 years. Both genders were equally affected. The main indications were infective keratitis (56.25%), congenital corneal opacity (18.75%) and trauma (12.50%). There were 62.50% of patients who had a preoperative visual acuity worse than 6/60. Fifty percent had other combined procedures during the surgery, including lens aspiration, peripheral iridectomy, pupilloplasty and glaucoma tube implant. Best corrected visual acuity of 6/12 or better was achieved in 18.75% of patients. A hazy graft was noted in 68.75% of patients, and was attributed to graft rejection, glaucoma and graft failure. There was a statistically significant association between the presence of vascularized cornea, intraocular inflammation and combined surgery with survival rate of the graft at one-year postoperative period (p < 0.05).ConclusionsInfective keratitis is the main indication for penetrating keratoplasty in our pediatric patients. Good visual outcome was documented in a small percentage of the patients. Amblyopia and hazy graft were the main barriers to success in this group of patients. Vascularized cornea, inflammation and combined surgery had significantly affected the survival rate of the grafts in our series.

Eye Bank Records on Pediatric Keratoplasty

“…[21] Table 3 summarizes published data on indications for pediatric keratoplasty in both developed and developing countries with the present study included. [5,7,8,12,[14][15][16][17][18][19][20][22][23][24][25][26][27][28][29] Keratoconus in our study, similar to the reports from pediatric keratoplasty in countries such as New Zealand, Italy, and Australia, was the most common indication for keratoplasty. [14][15][16] This was in contrast to the reports from the United States, Singapore, Saudi Arabia, Eastern China, Malaysia, and India in which congenital corneal abnormalities and corneal infections were the top causes of keratoplasty in the pediatric age group.…”

“…PKP, in our survey, was the most common surgical technique for pediatric keratoplasty, similar to the other reports in which PKP was the only or the predominant surgical procedure for pediatric corneal transplantation. [5,7,12,[14][15][16][17][18][19][20] The indications for pediatric keratoplasty differ worldwide depending on the geographic region. For instance, in developed countries, congenital corneal disorders and nontraumatic acquired keratectasias are the leading indications for pediatric keratoplasty, while acquired corneal scars and ulcers of traumatic or infectious etiologies are on the top in developing countries.…”

Pediatric Keratoplasty: The Success of a Tailor-Made Surgical Management

“…This often implies rapid graft rejection; the almost instantaneous and ferocious inflammatory response, along with a robust fibrin reaction, often results in significant scarring with subsequent ocular surface irregularity and instability [4]. Despite these difficulties, surgery is the first-line treatment of CCO in order to ensure the patient’s VA [5].…”

“…In the literature the outcomes of pediatric PKP surgery are heterogeneous [3, 5]. Previous research showed that 32.6–78.6% of grafts performed for CCO remain clear for >1 year [5]. However, when stratification criteria are applied, for example the underlying disease and the age of the patient, the outcomes are very different.…”

“…The multitude of different results, as for graft survival, reflects the variety of clinical presentations of patients requiring PKP or DALK intervention [12]. It is essential that in the setting and preparation of the surgery phase the main operator assess all the patient’s distinctive features; by careful examination of the anatomical details, all the variants of the different surgical steps to be performed can be weighted [3, 5]. It is precisely through this careful analysis that the nonoptimal results presented in the literature can be improved.…”