Survival of Primary Penetrating Keratoplasty in Children

Purpose To review the indications and outcomes of children undergoing primary penetrating keratoplasty and identify prognostic factors for graft survival. Design Retrospective, interventional case series. Methods Medical records of every child 12 years of age or younger who underwent primary penetrating keratoplasty at Wills Eye Hospital Cornea Service between 2007 and 2015 were reviewed. Survival of the primary graft was analyzed using the Kaplan-Meier survival method. Results Forty-six eyes of 35 children underwent primary keratoplasty during the study period. The mean age at the time of primary keratoplasty was 24.6 ± 39.9 months. The mean follow-up duration was 36.4 ± 28.8 months. Congenital opacity was the most common diagnosis for primary keratoplasty (89.1%). The overall mean graft survival time was 45.2 ± 5.8 months, with a survival rate of 75.7% at 1 year. The 1-year graft survival rate was 51.9% and 90.7% in eyes with and without glaucoma, respectively. Cox proportional hazards regression analysis demonstrated that the presence of glaucoma ( P  = .014) and concurrent operation during primary keratoplasty ( P  = .049) were independent prognostic factors for poor graft survival. On the other hand, age of primary keratoplasty ( P  = .626) and operation before or after primary keratoplasty ( P  = .800 and P  = .104, respectively) were not associated with poorer graft survival. Half of our patients were able to achieve ambulatory vision at the last follow-up. Conclusion Although pediatric penetrating keratoplasty is challenging, successful transplantation with good graft survival can be obtained. Better understanding of prognostic factors can possibly improve graft survival in the future.