Posters

Paediatric keratoplasty in a referral cornea center: indications and outcomes

Poster Details

First Author: R. Karadag UNITED STATES

Co Author(s):    T. Chan   C. Rapuano   K. Hammersmith   P. Nagra   A. Azari        

Abstract Details

Purpose:

To analyze the indications and outcomes of pediatric corneal transplantation surgery in a referral cornea center.

Setting:

The medical records of every child 12 years of age or younger who underwent their first keratoplasty at the Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA, between January 1, 2007, and December 31, 2015, were retrospectively reviewed.

Methods:

A structured form was used to extract and record information from patients’ records regarding age, gender, prior surgical procedures, clinical examination results, clinical diagnosis, concomitant ocular findings, postop follow-up, associated surgical procedures, outcomes of keratoplasty, postoperative complications, and graft clarity. Using a computerized patient database, 47 eyes of 36 patients were identified. 20 (55.6%) were female, and 16 (44.4%) were male. Both eyes were operated in 11 patients. The mean presenting age was 24.0+/-36.8 months, the mean age at surgery was 25.9+/-36.6 months, and the mean follow-up period was 33.0+/-28.6 months.

Results:

Patients’ diagnosis included Peters anomaly (61.7%), congenital glaucoma (10.6%), corneal ulcer (6.4%), aniridia with glaucoma (4.3%), persistent primer hyperplastic vitreous (4.3%), scarring after a ruptured globe repair (4.3%), sclerocornea (4.3%), and corneal dystrophies (4.3%). Eleven eyes had glaucoma before primary keratoplasties while 14 eyes had it after surgeries. Concurrent surgeries were performed at the time of primary keratoplasty in 55.3% of eyes. Eight eyes had undergone surgeries before the first keratoplasty and 16 eyes had non-transplant surgeries after the first keratoplasty. Primary graft survival was 59.5% at last follow-up visit. The mean time to graft failure was 17.3+/-20.3 months.

Conclusions:

The majority of pediatric corneal grafts performed at our institution are for Peters anomaly. Our results found that glaucoma is associated with an increased risk of history of another surgery before primary keratoplasty, additional concurrent intervention at the time of primary keratoplasty, and first graft failure and other complications including phthisis, endophthalmitis, and eventual need for a keratoprosthesis. Seven eyes were grafted twice, two eyes had three grafts, and one eye underwent four penetrating keratoplasties. At last follow-up visit, grafts were clear in 35 of 47 eyes (74.5%). The postoperative course is complex and sometimes involves re-grafting.

Financial Disclosure:

NONE