Evaluation Of Keratoplasty In The Pediatric Age Group

To evaluate keratoplasty in the pediatric age group as regards visual outcomes, graft survival and complications.

 Corneal transplant is the ultimate solution to restore visual acuity in children with corneal opacities. It is extremely challenging in infants and

toddlers because of the elastic sclera, shallow anterior chamber, anterior displacement of the lens–iris diaphragm, smaller size of the eyeball, and the poor

compliance and cooperation of the patients during examination, treatment, and postoperative care.

 A prospective clinical study was performed including 37 eyes of patients of different ages in the pediatric age group (below 18 years old),

undergoing keratoplasty

Preoperative assessment:

1- History: age, general history, past ocular history, refractive history. 2- UCVA & BCVA

3- MR if possible

4- Slit lamp

5- Retina & optic nerve examination when the media permits or by U/S, ERG and VEP

Method of keratoplasty was chosen by the surgeon according to the pathology involving the cornea either DALK or PKP Postoperative assessment:

Patients was followed up at 1, 3, 6, 12, 24 & 36 months postoperatively regarding:

1- UCVA & BCVA

2- MR if possible

3- Graft clarity

4- Postoperative complications as graft failure, rejection, suture infection

Most frequent indication was Keratoconus followed by post infectious keratitis opacity. 67.6% of the patients had PKP & 32.4% had DALK.

The comparison of graft findings during different periods of follow up showed that after 1 month the improvement of graft findings was significant, while all

over the next periods the change was insignificant.

Regarding UCVA, BCVA and keratometry, there was a significant improvement from the 1 st month till the long term follow up. Sphere & cylinder showed

significant change after 1, 3, 6, 12, 24 & 36 months.

Sutures status & IOP showed insignificant change all over the period of follow up.

Incidence of complications was 70.3%. Most common complication was graft rejection followed by cataract & fungal keratitis.

 Pediatric keratoplasty (whether PKP or DALK) has a favorable visual outcome when performed for different indications.Keratoconus is the

predominant indication for pediatric keratoplasty. This is followed by post microbial keratitis opacities. Graft clarity could be maintained in a great

percentage of cases after pediatric keratoplasty for a period of 1 to 3 years. Graft rejection, cataract, and fungal infection are the most common

complications in our series.