Long-Term Outcomes of Pediatric Keratoplasty at a Tertiary Care Center.

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To report the indications, postoperative visual outcomes, and long-term graft survival of primary pediatric keratoplasties performed at a single tertiary care center. We conducted a retrospective review of pediatric patients (16 years and younger) who underwent surgical intervention for corneal opacity at a tertiary care center to evaluate long-term graft survival and visual rehabilitation. Seventy-three eyes of 46 patients met inclusion criteria. The mean patient age at the time of transplantation was 7.44 years (range, 5 months-15.72 years), and the average follow-up time was 5.82 years. Forty eyes (56%) had graft failure occurring at a mean time of 16.33 months (range, 27 days-12.58 years), of which 25 eyes (62.5%) underwent repeat keratoplasty. Cumulative graft survival probabilities at 1, 3, 5, and 7 years after keratoplasty were 60%, 55%, 44%, and 44%, respectively. Cox proportional hazards regression analysis showed Black ethnicity [hazard ratio (HR) = 4.72; confidence interval (CI), 1.16-19.23], mixed/other ethnicity (HR = 6.67, CI, 1.58-28.16), and keratoplasty in combination with another procedure (HR = 2.88; CI, 1.35-6.15) as significant risk factors of graft failure. 47 eyes (64%) achieved ambulatory vision (20/800 or better) at the last follow-up. Age younger than 5 years at time of keratoplasty was associated with better visual outcomes in patients with congenital disease (P = 0.0017). Pediatric keratoplasty has a high rate of graft failure but can achieve ambulatory vision in >60% of patients. Keratoplasty outcomes are improved in non-Hispanic, White patients and when the intervention is performed alone. Younger age at time of keratoplasty for congenital conditions improves the likelihood of overall visual rehabilitation.