Penetrating Keratoplasty in Children

Retrospectively studied were 91 patients, 14 years of age or less, who had 152 penetrating keratoplasties in 107 eyes, with an average followup of 30.1 months. Survival analysis showed the probability of obtaining a clear graft at one year to be 60 ± 8% in 45 eyes with congenital opacities, 70 ± 8% in 31 eyes with opacities from trauma and 73 ± 8% in 31 eyes with acquired nontraumatic opacities. Most failures occurred during the first postoperative year and were characterized by the gradual loss of graft clarity from undetermined cause. Twenty-nine percent (10) of the 34 eyes with congenital corneal opacities in which vision could be measured had a most recent visual acuity better than 6/120 (20/400). Irreversible amblyopia, glaucoma, other structural abnormalities of the anterior segment and mental retardation complicated visual rehabilitation in the congenital group. In the post-traumatic group, vision was better than 6/120 (20/400) in 45% (13) of 29 eyes, being limited by vitreoretinal pathology, fibrous ingrowth, and optic nerve damage from glaucoma. Visual acuity in the acquired, nontraumatic group was better than 6/120 (20/400) in 67% (20) of 30 eyes. The percentage of patients achieving 6/12 (20/40) or better in the congenital, post-traumatic, and nontraumatic groups were 3% (1/34), 17% (5/29), and 47% (14/30), respectively. In the congenital group, only patients with posterior polymorphous dystrophy obtained a visual acuity of 6/30 (20/100) or better. Preoperative vascularization of the cornea, persistent epithelial defects, and performance of lensectomy-vitrectomy were factors most highly correlated with poor graft survival. Vitrectomy and postoperative aphakia were factors most highly correlated with poor final visual acuity. The data indicate that penetrating keratoplasty is becoming increasingly successful in children and suggest that future efforts should be aimed toward reducing the period of visual deprivation and providing more effective amblyopia therapy.