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Pediatric PK graft survival affected by cause of opacity, need for additional surgeries

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Corneal grafts survived in most pediatric patients with congenital heriditary endothelial dystrophy but failed in most cases with acquired or other congenital opacities, a study by researchers in Saudi Arabia found.

"[Most] cases of graft failure occur relatively early in the clinical course for non-CHED [congenital heriditary endothelial dystrophy] congenital opacities and acquired opacities," the authors said. "[We] recommend intensive observation and follow-up during this interval, with examinations as frequently as every 2 weeks during the first 3 months, every 4 weeks for the remainder of the first year, and at least every 6 to 8 weeks during the second year."

Ali Al-Ghamdi, MD, and colleagues at King Khaled Eye Specialist Hospital in Riyadh reviewed the outcomes for 165 eyes of 134 children treated with primary penetrating keratoplasty. All children were 12 years of age or younger, and most had congenital opacities, including 35 eyes with CHED. Other indications included acquired traumatic and non-traumatic opacities, according to the study.

At 50 months mean follow-up, 73 grafts (44.2%) remained clear and 92 grafts (55.8%) had failed. Of these failed grafts, 60 failed within 1 year postop and another 21 grafts failed within 2 years, the authors said.

Eyes with CHED had the best success rate, with 85.7% of grafts surviving at final follow-up. In contrast, 41.2% of grafts survived in eyes with traumatic opacities (P = .001), 32.6% survived in eyes with non-CHED congenital opacities (P < .001) and 27.8% survived in eyes with nontraumatic opacities (P < .001), according to the study.

Eyes with CHED were also significantly more likely to achieve ambulatory vision or vision better than 20/200 (P < .001), the authors noted.

The researchers found that graft failure occurred significantly more often in eyes that required additional surgical interventions (P = .02), particularly for glaucoma. Graft failure was also significantly more common in eyes that experienced major complications (P < .001), particularly glaucoma and microbial keratitis, according to the study.

The study is published in the February issue of the Journal of the American Association for Pediatric Ophthalmology and Strabismus.