The results of reconstructive penetrating keratoplasty in the children

Objective. To evaluate the immediate and long-term biological and functional results of reconstructive penetrating keratoplasty (RPKP) in the children. Materials and methods. We undertook a comparative analysis of the outcomes of 86 cases of the surgical intervention on 74 children presenting with corneal opacities of different etiology who had been treated with the application of reconstructive penetrating keratoplasty based at the Department of Eye Pathology in Children, The Helmholtz Moscow Research Institute of Eye Diseases. All operations were made by the same surgeon during the period from 2008 to 2014. The results of reconstructive penetrating keratoplasty were compared with the outcomes of conventional penetrating keratoplasty. The biological results were evaluated in terms of the graft survival (Kaplan-Meir’s) model. The duration of the postoperative follow-up period ranged from 5 months to 8 years and averaged 20,8 ± 9,7 months in the children treated with the use of reconstructive penetrating keratoplasty and to 3,0 ± 15,4 months in the patients treated by means of conventional penetrating keratoplasty. Results. During the early postoperative period (within 1 and 6 months after surgery), the difference in the graft survival rate between the two groups was practically non-existent. After 1 month, the transparency of the transplanted cornea was fairly well preserved in the children of both groups, but persisted for 6 months only in 72% and 95% of the patients treated by reconstructive and conventional penetrating keratoplasty respectively. One year after surgery, the graft survival in the children treated with the use of reconstructive penetrating keratoplasty was documented in 54% of the cases in comparison with 78% in the patients treated by means of conventional penetrating keratoplasty. The difference between the two groups was statistically significant (p < 0,05). Two and three years after surgery, the transparency of the transplanted cornea in the children treated with the use of reconstructive penetrating keratoplasty fell down to 50% and 20% respectively. During the same periods, the transparency of the transplanted cornea in the children treated by means of conventional penetrating keratoplasty remained as high as 76% and 62% respectively. Conclusion. Although the combination of penetrating keratoplasty with other surgical modalities results in the almost three-fold reduction of the probability of engraftment of the transparent corneal transplant in the remote postoperative period in comparison with the standard implantation of the donor cornea transplant, this operation provides the only possibility for the restoration of vision in the children suffering from severe corneal pathology.

children, corneal opacity, keratoplasty, graft survival