Penetrating Keratoplasty In Children Research Articles

Analysis of long-term outcomes of penetrating keratoplasty for congenital corneal opacity

Objective: To investigate the long-term outcomes of corneal grafts after penetrating keratoplasty(PK) for congenital corneal opacity(CCO) in children aged 0 to 5 years and the related influencing factors. Methods: It was a retrospective series case study. Data of 39 children (55 eyes) who underwent PK surgery due to CCO in the keratology Department of Beijing Tongren Hospital from April 2014 to April 2018 and were followed up for more than 30 months were collected. Among them, there were 17 males (43.6%) and 22 females (56.4%). The age at operation was (16.2±13.3) months, and the follow-up time was (46.4±13.8) months. Clinical data such as basic information, preoperative diagnosis, operation age, operation method and postoperative complications were recorded. The corneal graft transparency was analyzed according to preoperative diagnosis, corneal neovascularization area, age at surgery, monocular or binocular surgery interval, primary surgery type and further surgery, and postoperative complications were observed. Results: At 12 months, 24 months and the last follow-up after PK, 78.2% (43/55), 70.9% (39/55) and 58.2% (32/55) of the affected eyes had clear corneal grafts, respectively.There was no statistical significance between Peters anomaly and sclerocornea (P>0.05), while the extent of neovascularization in the limbus had a significant effect on corneal graft transparency, and graft opacity was more likely to occur in patients with vessel area exceeding 2 quadrants (P<0.05).The highest corneal graft transparency was found in children aged 1 to 3 years 80.8%(21/26) (P<0.05), followed by children younger than 6 months (7/15).The translucency rate of the corneal graft was higher in patients undergoing unilateral surgery than in those undergoing bilateral surgery (P<0.05).Translucency of corneal graft was higher in children with simple surgery than with combined surgery (P<0.05), however, cataract surgery after PK had no significant effect on corneal graft transparency (P>0.05).The postoperative complications mainly included immune rejection in 19 eyes (34.5%), complicated cataract in 13 eyes (23.6%), glaucoma in 7 eyes (13.2%), persistent corneal epithelial defect in 7 eyes (13.2%). Conclusions: After PK in children with CCO, the transparent rate of corneal grafts decreases gradually with time, but the long-term translucency of corneal grafts can still be obtained. The range of corneal neovascularization, age at the time of surgery, whether the surgery was binocular and whether the surgery was combined had an effect on the transparency of corneal graft.

Cataract surgery following penetrating keratoplasty in children.

Following penetrating keratoplasty, cataract surgery warrants certain modifications to ensure maximum survival of the graft. To emphasize the intraoperative challenges and surgical manipulations to be followed. The surgeon makes a superior sclerocorneal tunnel avoiding the graft host junction. Dispersive viscoelastic is used. Continuous curvilinear capsulorhexis is done. Cataractous lens aspirated with a low flow rate. The intraocular lens is placed in the bag. Superior peripheral iridectomy and primary posterior capsulorhexis are done. The wound closed with two interrupted 10-0 nylon sutures. Graft host junction integrity is maintained. Ensure 1. Good intraoperative corneal visibility, 2. Avoid graft host junction for main port incision 3. Generous dispersive viscoelastic use/soft shell technique to protect the corneal endothelium, 4. Avoid phaco energy in case of soft cataracts/low phaco energy and flow rates, 5. Phaco probe to be meticulously oriented away from corneal endothelium, 6. Primary posterior capsulorhexis to be done as in any pediatric cataract surgery, 7. Make sure of the graft host junction integrity at the end of the surgery, 8. Restrict to a single port whenever possible. https://youtu.be/tu4R5JangYs.

Keratoplasty for Keratoconus in Young Patients: Demographics, Clinical Features, and Post-transplant Outcomes

To examine pretransplant findings and outcomes of corneal transplants for keratoconus in children. Retrospective cohort (national registry) study. Data on all patients aged 16 or younger (n=170) who had a first transplant for keratoconus between 2003 and 2018 in all corneal transplant centers in the UK were compared to adult patients aged 17 and older (n=7,191). The influence of demographic variables, pretransplant corneal findings, and transplant type on 2-year visual, rejection-free, and transplant survival outcomes was examined. Children had poorer pretransplant visual acuity and higher rates of corneal vascularization and ocular surface disease than adults. However, 2-year post-transplant corrected visual acuity reached 20/20 or better in 35% of children compared to 28% of adults (P=.1). Transplant rejection and failure rates were 11% (P=.79) and 3% (P=.31), respectively, for children, which were comparable to rates for adults. Endothelial rejection was reported following penetrating keratoplasty (PK) in 13% of children (10% in adults). Irreversible rejection was not recorded for any transplant in a child. Despite a lack of difference in transplant outcomes, there was a significant age effect in the Cox regression model for transplant rejection, such that for every 5-year increase in age there was a 6% reduction in the hazard of rejection. Transplant survival following anterior lamellar keratoplasty and PK in children was similar. Young keratoconus patients have excellent transplant outcomes and visual results comparable to adults. Overall, the hazard of rejection was found to decrease with advancing age. However, in this large cohort of young patients with keratoconus and poor vision, there is no evidence of outcome advantage in delaying transplant until adult years.

Сквозная кератопластика у детей: результаты хирургического лечения

Penetrating keratoplasty (PK) in children is a complex and ultifaceted problem that has been experiencing pediatric ophthalmology for several decades With all its radicality and with all its therapeutic potential, most surgeons prefer, nevertheless, to refuse to transplant the cornea in childhood, and transfer it to a later date, especially in infants (up to a year). In the absence of alternative interest in this operation did not fade, the practice of corneal transplantation in children continued and improved. The desirability of PK in corneal opacities (CO) in children is no longer discussed as such. On the agenda is another question: how to make this operation a truly effective way of treatment. This is not an easy task in itself, with many problems. Among them – the complexity of communication with a young patient, a special plasticity of the tissues of the child’s eye, heavy, as a rule, the combined nature of the pathology, predisposition to violent inflammatory reactions, etc. In many years of practice, for the most part, by trial and error, these problems are gradually finding their solution. An empirical experience always precedes the understanding of the problem and the search for its solution, no matter how unsuccessful it may seem at the very beginning. This work is devoted to generalization of such experience. Objective . To Evaluate the immediate and long-term results of penetrating keratoplasty in children. Material and methods. Retrospectively and prospectively analyzed the medical history and hospital records of children operated in the Department of pathology of eyes in children, Moscow Helmholtz Research Institute of Eye Diseases in the period from 1997 to 2017. The total sample consisted of 208 cases of the PK, was performed in 185 children on 208 eyes. By the nature of the disease, all observations were divided into congenital and acquired CO. Among the latter, turbidity of traumatic and non-traumatic nature was distinguished. Biological and functional results of PK were evaluated. The biological result of the operation was evaluated in terms of graft survival (Kaplan-Mayer model). The functional result was estimated approximately: by tracking the child’s toys from a certain distance and by the method of pr eferred gaze. Results . The first 6 months after the surgery, the transplants, with rare exceptions, remained transparent. By the end of the 1st year, 72% of transplants remained transparent, by the end of the 2nd year not less than 65%, by the end of the 3rd year-not less than 55%, by the end of the 5th year not less than 45% of transplants. In search of a more rigorous determination of the results, PK assessed the impact of particular clinical circumstances on the engraftment of transplants. It turned out that regardless of the etiology of the disease graft survival is significantly lower if keratoplasty is carried out in a vascularized couch, if simultaneously with corneal transplantation are other optical-reconstructive surgery: cataract extraction, vitrectomy, plastic iris, if the diameter of the transplant >8 mm, in the eyes with glaucoma in history. Transparency of transplants is significantly reduced in complicated postoperative course: recurrent rejection crises, increased IOP or the appearance of synechiae. In at least 80% of patients, corneal transplants have resulted in improved visual aquity (VA). In most of these cases, VA increased from light perception to 0.1-0.3. Satisfactory results, when VA after surgery reached 0.6-0.8, were in patients with keratoconus and congenital hereditary corneal dystrophy. Among those who have measured hundredth of VA dominated children with severe congenital malformations of the cornea and anterior segment of the eye. Conclusion . PK in children today is a very successful surgical intervention, the therapeutic potential of which can be realized with proper consideration of risk factors, impeccable technique and careful postoperative monitoring.

Visual Outcomes and Prognostic Factors of Successful Penetrating Keratoplasty in 0- to 7-Year-Old Children With Congenital Corneal Opacities.

To determine the visual acuity and prognostic factors after successful penetrating keratoplasty (PK) in 0 to 7-year-old children with congenital corneal opacities. Sixty eyes (50 patients) with clear grafts after PK for congenital corneal opacity were enrolled and followed for 6 to 82 months. Visual acuity was measured using Teller acuity cards or Snellen charts, and cycloplegic refraction and flash visual-evoked potentials were measured. Mean age at primary keratoplasty was 2.5 ± 1.7 years. The mean follow-up duration was 18.9 ± 19.3 months. Ambulatory vision (≥20/960) was achieved in 43 of 60 eyes (71.7%) at last follow-up, and 14 eyes (23.3%) had visual acuities >20/260. Compared with unilateral opacity eyes (58.8%), a significantly higher proportion of bilateral opacity eyes (88.5%) achieved ambulatory vision (P = 0.012). Of all the surgical indications, unilateral sclerocornea was associated with the worst visual outcome-only 12.5% obtained ambulatory vision. Additional intraocular surgery was also associated with a reduced ambulatory visual acuity outcome. There were no significant differences in visual acuity among the different follow-up subgroups (<12 months, 12-36 months, and >36 months after operation; P = 0.928). Patients with bilateral opacity had a higher proportion of abnormal amplitude flash visual-evoked potentials than did patients with unilateral opacity (P = 0.033). Ten of the 14 eyes that achieved 20/260 vision had corneal astigmatism ≤3 diopters. Most of the clear grafts after PK in children with congenital corneal opacities achieved ambulatory vision. The visual outcome was better in binocular opacity cases than in monocular ones.

Infectious keratitis after penetrating keratoplasty: predisposing risk factors and prognosis

PurposeTo investigate prevalence, predisposing risk factors and prognosis of graft survival in patients who developed infectious keratitis following penetrating keratoplasty (PK).Methodswe undertook a retrospective analysis of 16 patients hospitalized at the Institute of Ophthalmology of Tunis for the occurrence of infectious keratitis following PK over an seven‐year period (From March 2009 to March 2016). We excluded all herpetic keratitis secondary to PK. Efficacy of treatment was evaluated by anatomical (clarity of graft) and visual recovery.ResultsPrincipal indications for PK were corneal opacity (secondary to infectious keratitis in 2 cases and to trachoma in 2 cases), therapeutic penetrating keratoplasty for corneal perforation in 5 cases, keratoconus in 3 cases, pseudophakic bullous keratopathy in one case and penetrating keratoplasty in children in 3 cases. Principal predisposing risk factors were suture‐related problems (56.25%) followed by topical corticotherapy (43.75%) and persistant epithelial defect in (43.75%). The microbiological examinations were positive in 70.58% of the cases: bacillus Gram +: 66.66%, Bacillus Gram Négatif: 8.33%, amoeba: 8.33% of the cases. We noted two cases of polymicrobial infection. Four patients underwent PK. The infection was solved in 100% of the cases but with opacities of the transplant in 75% and a severe limitation of the visual acuity.ConclusionsThe development of infectious keratitis after PK is a serious complication that is associated with a high incidence of graft failure and poor visual outcome. Preventive measures are essential and include a regular follow‐up and education of the operated patients.

Endothelial keratoplasty in children.

Descemet stripping endothelial keratoplasty has superseded penetrating keratoplasty (PKP) in adults as the procedure of choice for treating endothelial dysfunction, but endothelial keratoplasty despite the multitude of advantages has undergone a much slower adoption in pediatric patients. This review focuses on the recent advances made in the field of pediatric endothelial keratoplasty and the associated surgical challenges. Pediatric endothelial keratoplasty does not require as many sutures as PKP, and the wound size is smaller and more stable. Endothelial keratoplasty grafts clear faster, possibly allowing for a more effective management of amblyopia. Visual outcomes appear to be comparable with PKP but with a lower complication rate. As corneal surgeons grow more and more familiar with the nuances of pediatric endothelial keratoplasty, our understanding of this procedure will become more complete. The limited data available suggest that endothelial keratoplasty is a suitable surgical alternative to PKP in children.

Paired-eye comparison of Descemet's stripping endothelial keratoplasty and penetrating keratoplasty in children with congenital hereditary endothelial dystrophy

PurposeTo report the surgical outcomes of Descemet's stripping endothelial keratoplasty (DSEK) in cases of congenital hereditary endothelial dystrophy (CHED) cohort and compare it with penetrating keratoplasty (PK) in a paired-eye...

Pediatric Keratoplasty

Penetrating keratoplasty in children is a highly challenging and demanding procedure associated with a high risk of graft failure or failure of amblyopia therapy in clear grafts. Nonetheless, keratoplasty remains the surgery of choice for the management of pediatric corneal stromal opacities or edema. Allograft rejection, graft infection, corneal neovascularization, glaucoma, trauma to the anterior segment, vitreous pathology, and additional surgical interventions, especially those related to glaucoma management, are important risk factors. Successful penetrating keratoplasty in children requires careful preoperative evaluation and selection of patients follow-up by well-motivated parents, an expert corneal transplant surgeon, and a devoted pediatric ophthalmologist.

Primary pediatric keratoplasty: Indications, graft survival, and visual outcome

Penetrating keratoplasty in children has been documented to have a higher rate of graft failure and a worse visual prognosis than adult keratoplasty. We undertook a retrospective review of all cases of primary penetrating keratoplasty performed in children 12 years of age or younger at the King Khaled Eye Specialist Hospital between January 1, 1990, and December 31, 2003. One hundred sixty-five primary penetrating keratoplasties were performed in 134 children during the study interval. The surgical indications were congenital opacities in 130 eyes (78.8%), acquired, traumatic opacities in 18 eyes (10.9%), and acquired, nontraumatic opacities in 17 eyes (10.3%). Among congenital opacities, 35 cases were caused by congenital hereditary endothelial dystrophy (CHED). The median follow-up for 73 grafts (44.2%) that remained clear was 50 months (range, 12-50 months), whereas the median follow-up for 92 grafts (55.8%) that failed was 6 months (range, 1-54 months). Kaplan-Meier graft survival was significantly higher at all postoperative intervals in eyes with CHED than for other surgical indications (p < 0.001). Eyes with CHED were significantly more likely to achieve ambulatory vision or vision >20/200 than eyes with other indications (p < 0.001). Pediatric keratoplasty was associated with an excellent prognosis for graft survival in eyes with CHED and a fair prognosis for graft survival in eyes with non-CHED congenital opacities and acquired opacities. The best visual prognosis was obtained in eyes with CHED and the worst prognosis was for non-CHED congenital opacities.

Penetrating keratoplasty in children

目的 评价儿童穿透性角膜移植术的意义及讨论如何提高手术成功率.方法采用穿透性角膜移植术对不同病因所致的儿童角膜浑浊11例(11眼)进行治疗,术后随访12～24月.结果植片透明率63.64%,9例术后裸眼视力有不同程度提高.结论儿童穿透性角膜移植术效果较成人差,但有重要的临床意义和社会意义。