title: Penetrating keratoplasty in the mentally retarded.
abstract: Penetrating keratoplasty is infrequently performed in the mentally retarded due to the high risk of serious post-operative complications, in particular wound rupture and severe inflammation of the graft. Graft survival is hindered by the patient's tendency for eye rubbing and possibly self-inflicted injury. Adequate nursing support is essential to ensure strict compliance with post-operative treatment. A retrospective study of corneal graft outcomes in mentally retarded patients was undertaken to assess graft survival, visual rehabilitation, post-operative complications and the influence on social behaviour. Six cases of penetrating keratoplasty performed in mentally retarded patients by one surgeon are presented. A continuous 10-0 nylon suture was employed in all cases. In 2 cases surgery was undertaken following perforation of the globe in patients with Down's syndrome. The grafts were retained in all cases and 2 patients achieved reasonably good acuity, although formal visual acuity assessment in these patients is limited. Penetrating keratoplasty in mentally retarded patients is a potentially hazardous procedure and patients require close supervision and good support care. This series demonstrates that relatively successful outcomes can be obtained in some mentally retarded patients.
authors.affiliation: Royal Preston Hospital, Preston, Lancs, UK.
authors.forename: A M
authors.initials: AM
authors.lastname: McElvanney
authors.forename: H P
authors.initials: HP
authors.lastname: Adhikary
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection; D006801:Humans; D008607:Intellectual Disability / Q000150:complications*; D007640:Keratoconus / Q000601:surgery*; D015948:Keratoplasty, Penetrating / Q000534:rehabilitation; D008297:Male; D011183:Postoperative Complications; D012189:Retrospective Studies; D016896:Treatment Outcome; D014792:Visual Acuity