Anatomical success of tectonic keratoplasty in children at a tertiary care eye hospital.

Abstract

To evaluate the anatomical outcome of tectonic grafts performed in children with perforated or melted corneas. The prospective study was conducted at the Department of Paediatric Ophthalmology, Al-Shifa Trust Eye Hospital, Rawalpindi, Pakistan, from January to December 2017, and comprised children of either gender aged <16 years who received tectonic grafts owing to desmetocoele or corneal perforation of >3mm. The causes of corneal perforation, size of perforation, post-operative graft outcome and globe integrity were noted. Periodic follow-ups were done till December 2019. Data was analysed using SPSS 22. Of the 27 patients, 9(33.3%) were girls and 18(66.7%) were boys. The overall mean age was 47.7±43.5 months. The most common indication was corneal perforation 19(70.4%), followed by descemetocoele 8(29.6%). The most frequent cause was infectious keratitis 13(48.2%), followed by trauma 8(29.6%) and vitamin A deficiency 5(18.5%). The mean size of perforation/descemetocoele was 5.5±1.5mm. Post-operatively, graft failure occurred in 5(18.5%) eyes and required repeat grafts. Globe integrity was restored in all 27(100%) cases, and 24(88.8%) eyes maintained their size and intraocular pressure, while 3(11.1%) became phthisical. Post-operative visual acuity was better than 6/36 in 3(11.1%) eyes, between 6/36 and 6/60 in 10(37%) and counting finger in 14(51.8%). Tectonic graft was found to be a valuable therapeutic option in emergency globe-threatening corneal thinning and perforation and in maintaining the anatomical integrity of eyes.