A NEW CENTURY OF PEDIATRIC TRANSPLANTATION?

K.A. Williams¹, M. Lowe¹, M.C. Keane², D.J. Coster^1
1Ophthalmology, Flinders University, Bedford Park/AUSTRALIA, ²Ophthalmology, Flinders University, Bedford Park/SA/AUSTRALIA

Body: Introduction. We investigated factors affecting penetrating corneal graft survival and visual outcome in a cohort of pediatric patients, aged from newborn to <20 years.
Methods. Records of 14,865 followed penetrating corneal grafts in 11,929 patients submitted to the Australian Corneal Graft Registry by 381 ophthalmic surgeons and 253 follow-up practitionersfrom May 1985 to December 2009 were searched. We identified 765 grafts in 640 patients aged less than 20 years of age at time of graft. Graft survival was analysed using Kaplan-Meier survival plotsand Cox proportional hazards regression. Visual outcomes were analysed using best-corrected Snellen acuity at the time of the most recent follow-up.
Results. Infants aged <5 years at the time of transplantation exhibited poorer graft survival than children aged 5 to 12 years. The major indication for graft in infants was Peters’anomaly. In contrast, adolescents aged 13 to 19 years exhibited excellent corneal graft survival. Keratoconus was the major indication for graft in adolescents, accounting for 86% of cases. Inmultivariate analysis, factors significantly affecting corneal graft survival in pediatric patients included indication for graft, graft inflammation, history of intra-ocular surgery, cornealneovascularisation, occurrence of rejection episodes, post-graft operative procedures and the need for refractive surgery. Fourteen percent of pediatric grafts failed, of which 65% failed within 2years post-graft. Forty-four percent of failures were due to unknown causes (n=18) or to irreversible immunological rejection (n=30). Visual acuity was affected by indication for graft, with themajority (75%) of patients grafted for keratoconus displaying better than 20/40 vision at the most recent follow-up, while a large proportion (71%) of patients grafted for any other reason achieved avisual outcome of 20/50 or worse. However, overall 46% of the cohort had achieved 20/40 vision or better in both eyes at the time of most recent follow-up.
Conclusion. Corneal graft survival and visual outcomes are affected more by indication for graft than recipient age. Corneal grafts for keratoconus in adolescents show excellent survival.Corneal grafts performed for Peters’ anomaly exhibit poor graft survival and visual outcomes. The major reason for graft failure in all age groups was irreversible rejection. Investigation ofvisual outcomes indicated that the percentage of patients with initially poor vision overall (less than 20/50 in both eyes) was reduced from 41% to 12% of the cohort. Corneal transplantation improvesoverall bilateral vision in pediatric patients.

Disclosure: All authors have declared no conflicts of interest.