PENETRATING KERATOPLASTY IN THE FIRST YEAR OF LIFE: CHALLENGES, COMORBIDITIES AND CLINICAL OUTCOMES FROM A SIX-YEAR EXPERIENCE

To evaluate demographic, perinatal, clinical, surgical and postoperative characteristics of infants (≤12 months) undergoing penetrating keratoplasty at a national tertiary center in Türkiye.

Department of Ophthalmology, Faculty of Medicine, Istanbul University, Istanbul, Türkiye

A retrospective analysis was conducted on infants who underwent penetrating keratoplasty between 2019 and 2025. Demographic, perinatal, ocular and surgical parameters, along with postoperative outcomes, were evaluated descriptively (mean ± SD, range, frequency/percentage).

A total of 11 eyes from 8 infants were analyzed (mean age at presentation: 4.0 ± 4.0 months; range: 1–12). Mean follow-up was 20.1 ± 14.7 months (range: 3–49), with an average of 33.1 ± 22.9 examinations per patient (range: 4–82). The primary presenting findings were corneal opacity in 9 eyes (81.8%), keratitis in 1 (9.1%) and a cornea-covering dermoid cyst with peripheral corneal vascularization in 1 (9.1%). Six infants (75.0%) were born full-term and two (25.0%) preterm at 34 weeks of gestation. Admission to the neonatal intensive care unit (NICU) immediately after birth was required in five (62.5%).  Associated ocular findings accompanying corneal opacity included glaucoma (n = 1), glaucoma with nystagmus (n = 1), isolated nystagmus (n = 2), keratitis with epithelial defect (n = 1) and entropion with dermoid (n = 1). No additional ocular pathology was observed in five eyes, three of which were diagnosed with Peters anomaly type 1. Systemic comorbidities were absent in seven infants (87.5%), while one had cardiac anomaly, hearing loss, and factor VII deficiency. Six infants (75.0%) were referred from other centers, while two (25.0%) presented directly. At presentation, light sensitivity was present in three eyes (27.3%), suspicious in six (54.5%), and absent in two (18.2%). Intraocular pressure was elevated in two eyes (18.2%) and normal in nine (81.8%). At final follow-up, grafts were clear in seven eyes (63.6%), edematous in three (27.3%), and not assessable in one (9.1%) due to death. Postoperative ocular complications included pupil deformity in three eyes, graft rejection in two, pupil deformity with exotropia in one, pupil deformity with iris hyperpigmentation in one, and retinal detachment in one; two eyes showed no complications. One eye could not be evaluated due to exitus. Subsequent ocular surgeries were required in six eyes (54.5%), including pupiloplasty in three, repeat penetrating keratoplasty once in one and twice in one and combined pupiloplasty + synechiotomy + corneal suture revision in one. Four eyes (36.4%) required no additional surgical intervention.