Early outcomes of primary pediatric keratoplasty in patients with acquired, atraumatic corneal pathology

Purpose: To evaluate the early outcomes of pediatric corneal transplantation in patients with acquired, nontraumatic corneal pathology. Methods: In this retrospective series, the records of children 15 years of age or younger who underwent optical penetrating keratoplasty for acquired nontraumatic corneal pathologies between December 2008 and June 2010 were reviewed. Demographic features, etiology of opacification, visual acuity, and other clinical findings were recorded. Results: Nineteen eyes of 19 children (10 females) were included. Mean age at time of surgery was 9.1 ± 3.01 years (range, 5-15 years). Adherent leukoma secondary to healed infectious keratitis (n = 12, 63%) and keratoconus (n = 7, 37%) were the leading indications for surgery. The mean follow-up period was 10.2 ± 3.3 months (range, 6-18 months). Postoperatively, clear grafts were seen in 15 cases (79%). Graft failure was noted in 4 eyes secondary to allograft rejection (n = 1), graft infection (n = 1), primary graft failure (n = 1), and uncontrolled glaucoma (n = 1). The most common cause of moderate or poor visual outcome was amblyopia (80%). Overall, 13 patients (68%) had postoperative visual acuity better than the preoperative vision. Conclusions: Penetrating keratoplasty can yield good anatomic results in children with acquired, nontraumatic causes of corneal scarring, but amblyopia limits the visual outcomes.