Outcome of penetrating keratoplasty after ocular trauma in children

M. R. Dana, D. A. Schaumberg, A. L. Moyes, J. A. Gomes, P. R. Laibson, E. J. Holland, A. Sugar and J. Sugar
Cornea Service, Wills Eye Hospital, Philadelphia, PA 19107, USA.

OBJECTIVE: To characterize the outcome of penetrating keratoplasty in children for the visual rehabilitation of corneal injury. DESIGN: Multicenter retrospective study of the outcome of penetrating keratoplasty for ocular trauma in children. PATIENTS: All children aged 12 years and younger who underwent penetrating keratoplasty between January 1975 and May 1993 for penetrating corneal (n = 18) or corneoscleral (n = 3) trauma and nonpenetrating corneal trauma (n = 1). MAIN OUTCOME MEASURES: Graft survival and postoperative visual acuity improvement. RESULTS: Twenty-two children underwent 25 penetrating keratoplasties during the study period. Graft survival was 84% at 1 year and 70% at 2 years after surgery. Visual acuity improved in 15 (83%) of the 18 children with measurable preoperative and postoperative vision. Children with posterior segment injury before keratoplasty were less likely to maintain a clear graft (P = .04) and less likely to have improved vision postoperatively (P = .06). Children who received amblyopia treatment and appropriate optical correction postoperatively were more likely to have visual improvement than those who did not (P = .02). CONCLUSIONS: Penetrating keratoplasty for corneal trauma is generally a successful operation in the pediatric age group, with visual improvement seen in more than four fifths of cases. Graft survival and visual outcome are best in patients with trauma limited to the anterior segment. Aggressive postoperative refractive correction and amblyopia management also appear to contribute to a better visual outcome in pediatric keratoplasty.