The Outcomes of Primary Pediatric Keratoplasty in Singapore

Purpose To evaluate the long-term corneal graft survival and risk factors for graft failure in pediatric eyes. Design Retrospective, interventional consecutive case series. Methods Unilateral eyes of 105 patients aged 16 years and below were included from the Singapore Corneal Transplant Study between April 4, 1991 and April 4, 2011. Corneal graft survival was calculated using Kaplan-Meier survival analysis, and survival distributions were compared using log-rank test. Results Mean recipient age was 8.38 ± 5.63 years (range 0.18–15.92 years). Mean follow-up time was 34.16 ± 39.10 months. Main diagnoses were corneal scar (22.9%), limbal dermoid (21.9%), anterior segment dysgenesis (15.2%), and keratoconus (14.3%). Forty-four eyes (41.9%) underwent penetrating keratoplasty (PK), 37 (35.2%) underwent anterior lamellar keratoplasty (ALK), 22 (21.0%) underwent lamellar corneal patch graft, and 2 (1.9%) underwent Descemet stripping automated endothelial keratoplasty (DSAEK). Kaplan-Meier survival rates for PK were 92.8% at 1 year, 88.9% at 2–4 years, and 80.9% at 5–16 years; survival rates for ALK were 88.0% at 1 year and 84.3% at 2–7 years; survival rates for corneal patch graft were 100% at 1–3 years and 90% at 4–10 years; these were not statistically significant ( P  = .362). Deep corneal vascularization ( P  = .012), preexisting active inflammation ( P  = .023), preexisting glaucoma drainage device ( P  = .023), and preexisting ocular surface disease ( P  = .037) were associated with reduced graft survival in a univariate analysis. Conclusions We report good long-term graft survival following pediatric keratoplasty for various indications. Lamellar keratoplasty, when indicated, should be the procedure of choice in high-risk keratoplasties.