Oversized grafts in children

Abstract

Objective To evaluate the efficacy of oversized corneal grafts in the pediatric age group. Design Prospective, nonrandomized clinical trial. Participants and intervention Forty pediatric patients with unilateral or bilateral corneal opacification of congenital or acquired origin underwent corneal grafting surgery over a period of 2 years using donor corneal buttons oversized by 1 mm. Main outcome measures The parameters evaluated were indications for keratoplasty, graft clarity, visual acuity, keratometry, spherical equivalent, anterior chamber depth, and complications. Results Corneal ulceration was the most common cause of corneal opacification (25%), followed by trauma (20%) and sclerocornea (20%). At 1 year, clear grafts were achieved in 85% of the cohort. The average keratometry at the end of 1 year was 43.28 ± 1.65 diopters (D) in the congenital opacity group and 43.04 ± 2.20 D in the acquired group. The keratometric astigmatism was 3.60 ± 2.60 D in the congenital group and 2.52 ± 2.20 D in the acquired group. Oversized grafts provided an adequate anterior chamber depth of 2.20 ± 0.612 mm in the congenital group and 2.36 ± 0.302 mm in the acquired group. Visual acuity of 20/80 or better was recorded in only 30% of cases in the congenital group as opposed to 47% with acquired opacities. Nine cases had episodes of graft rejection. Conclusion Oversizing donor buttons by 1 mm provides adequate anterior chamber depth and increases the morphologic success of corneal grafting in children.