Anatomic and visual outcomes of corneal transplantation during infancy

Abstract

IntroductionThis study assessed the effect of age at penetrating keratoplasty (PKP) on graft survival and visual outcome in children transplanted during infancy. We previously presented (AAPOS 2011) a pilot study (14 children), suggesting early PKP improves vision without increased graft failure. This study adds outcomes from 53 additional children.MethodsMulticenter, retrospective cohort study of infants undergoing PKP at Children’s Hosptial of Philadelphia or New York Medical College, 1998-2011. PKP was categorized early (0-90 days) or late (91-365 days). Outcomes were graft survival and vision, classified poor, fair, good considering method (fixation, teller, optotype) and age norms.Results67 children (79 eyes) were studied: 25 eyes early-PKP, 54 late-PKP; 76/79 congenital opacities; mean follow-up 19.5 months (range, 1-147). Kaplan-Meier graft-survival estimates were 0.80 at 1.1 years (95% CI, 0.69-0.88), 0.47 at 5.8 years (0.30-0.61). Graft survival (64% early-PKP, 64.8% late-PKP, P = 1.00) and time to failure (Cox-proportional hazards) did not differ. Among 64 eyes with acuity measurements, no significant difference existed in proportion with good acuity between early PKP (36%) and late PKP (57%) (P = 0.19).DiscussionAlthough early infancy is a critical period of visual development, there was no advantage to early PKP. Possible confounding factors not controlled for in the analysis include degree of baseline ocular or neurological abnormalities and intensity of visual rehabilitation (amblyopia treatment, etc).ConclusionsOne-half of infant grafts survive >5 years. Clearing congenital corneal opacities in the first 3 months of life did not improve visual outcome. Early PKP did not worsen graft survival, but PKP may be technically easier to perform later in infancy. IntroductionThis study assessed the effect of age at penetrating keratoplasty (PKP) on graft survival and visual outcome in children transplanted during infancy. We previously presented (AAPOS 2011) a pilot study (14 children), suggesting early PKP improves vision without increased graft failure. This study adds outcomes from 53 additional children. This study assessed the effect of age at penetrating keratoplasty (PKP) on graft survival and visual outcome in children transplanted during infancy. We previously presented (AAPOS 2011) a pilot study (14 children), suggesting early PKP improves vision without increased graft failure. This study adds outcomes from 53 additional children. MethodsMulticenter, retrospective cohort study of infants undergoing PKP at Children’s Hosptial of Philadelphia or New York Medical College, 1998-2011. PKP was categorized early (0-90 days) or late (91-365 days). Outcomes were graft survival and vision, classified poor, fair, good considering method (fixation, teller, optotype) and age norms. Multicenter, retrospective cohort study of infants undergoing PKP at Children’s Hosptial of Philadelphia or New York Medical College, 1998-2011. PKP was categorized early (0-90 days) or late (91-365 days). Outcomes were graft survival and vision, classified poor, fair, good considering method (fixation, teller, optotype) and age norms. Results67 children (79 eyes) were studied: 25 eyes early-PKP, 54 late-PKP; 76/79 congenital opacities; mean follow-up 19.5 months (range, 1-147). Kaplan-Meier graft-survival estimates were 0.80 at 1.1 years (95% CI, 0.69-0.88), 0.47 at 5.8 years (0.30-0.61). Graft survival (64% early-PKP, 64.8% late-PKP, P = 1.00) and time to failure (Cox-proportional hazards) did not differ. Among 64 eyes with acuity measurements, no significant difference existed in proportion with good acuity between early PKP (36%) and late PKP (57%) (P = 0.19). 67 children (79 eyes) were studied: 25 eyes early-PKP, 54 late-PKP; 76/79 congenital opacities; mean follow-up 19.5 months (range, 1-147). Kaplan-Meier graft-survival estimates were 0.80 at 1.1 years (95% CI, 0.69-0.88), 0.47 at 5.8 years (0.30-0.61). Graft survival (64% early-PKP, 64.8% late-PKP, P = 1.00) and time to failure (Cox-proportional hazards) did not differ. Among 64 eyes with acuity measurements, no significant difference existed in proportion with good acuity between early PKP (36%) and late PKP (57%) (P = 0.19). DiscussionAlthough early infancy is a critical period of visual development, there was no advantage to early PKP. Possible confounding factors not controlled for in the analysis include degree of baseline ocular or neurological abnormalities and intensity of visual rehabilitation (amblyopia treatment, etc). Although early infancy is a critical period of visual development, there was no advantage to early PKP. Possible confounding factors not controlled for in the analysis include degree of baseline ocular or neurological abnormalities and intensity of visual rehabilitation (amblyopia treatment, etc). ConclusionsOne-half of infant grafts survive >5 years. Clearing congenital corneal opacities in the first 3 months of life did not improve visual outcome. Early PKP did not worsen graft survival, but PKP may be technically easier to perform later in infancy. One-half of infant grafts survive >5 years. Clearing congenital corneal opacities in the first 3 months of life did not improve visual outcome. Early PKP did not worsen graft survival, but PKP may be technically easier to perform later in infancy.