Corneal Topographic And Aberrometric Outcomes Before And After Keratoplasty In Pediatric Keratoconus: A Long-Term Follow-Up Study

To evaluate corneal topography and aberrometry results in the long-term follow-up of pediatric patients who underwent keratoplasty (KP) due to keratoconus (KC), and to compare preoperative and postoperative findings.

The medical records of pediatric patients who underwent KP for KC between 2004 and 2023 at the Akdeniz University Department of Ophthalmology were reviewed.

Best-corrected visual acuity (BCVA), age, sex, graft survival, and corneal topography parameters measured by Pentacam (Oculus Optikgeräte GmbH, Wetzlar, Germany) including keratometry values, central corneal thickness (CCT), thinnest corneal thickness (TCT), and corneal aberrometry measurements were evaluated at the last follow-up visit. Preoperative and postoperative aberrometry values were compared. A total of 48 eyes that had completed suture removal and had at least 2 years of follow-up after KP were included in the study.

The mean age of the patients was 15.45 ± 1.8 years(11–18).Postoperative glaucoma was observed in 5 patients(10.41%),and graft rejection occurred in 1 patient (2%).The mean trephine size was 7.55±0.1 mm,and the mean donor punch size was 7.82±0.14 mm.The mean preoperative BCVA was 0.94 ± 0.46 logMAR, which improved to 0.28 ± 0.3 logMAR postoperatively. The mean follow-up duration was 100 ± 36 months.Preoperative keratometry(K)1 was 56.9 D and decreased to 42.5 D postoperatively;preoperative K2 was 63.3 D and decreased to 49.1 D postoperatively.The mean K value decreased from 59.9 D preoperatively to 45.6 D postoperatively.The mean CCT was 399 µm preoperatively,565 µm postoperatively, while TCT was 348 µm preoperatively,542µm postoperatively.

There was a statistically significant decrease in total, lower-order,higher-order aberrations, and spherical aberration postoperatively (p<0.05). However, no significant difference was observed in trefoil and coma aberrations (p>0.05).No statistically significant differences were found between patients who underwent deep anterior lamellar keratoplasty and penetrating KP in terms of keratometry,aberrometry values,or BCVA. KP in pediatric keratoconus patients is a challenging procedure due to the risk of graft rejection and the possibility of amblyopia. In our study, both the improvement in visual acuity and the reduction in aberrations following KP suggest a significant enhancement in optical quality in pediatric KC patients.