Penetrating keratoplasty in young children with congenital hereditary endothelial dystrophy.
OBJECTIVE
To report the visual results and success rate of penetrating keratoplasty (PKP) in a series of young children with congenital hereditary endothelial dystrophy (CHED).


METHODS
This is a retrospective study on twenty-four eyes of 15 patients (seven male and eight female) operated on for CHED. Children less than 12 years of age at the time of surgery who were followed for at least 6 months were recalled. Characteristics of the patients, indications for PKP, final visual outcome, and graft clarity were evaluated. The following tests were employed: McNemmar test for evaluating visual results, Kaplan-Meyer analysis for determination of graft survival, and Mann-Whitney U test for evaluating the relationship between visual outcome and age at PKP.


RESULTS
Patients' age at diagnosis and at initial PKP was 6.5 +/- 3.6 and 8.1 +/- 2.5 years, respectively. Follow-up period was 35.5 +/- 36.2 months. Visual acuity could be evaluated by Snellen chart in 19 eyes. Preoperative visual acuity was less than 20/80 in all of these. Postoperatively, visual acuity was less than 20/80 in nine eyes (47.4%) (P < 0.002). Visual acuity improved in 18 (94.7%) of 19 eyes. There was no relationship between age at initial PKP and final visual outcome (P = 0.35). At the last examination (24 grafts), 19 were clear (79.1%), two were hazy (8.3%), and three were opaque (12.5%). Allograft rejection was seen in 10 eyes (43.4%), seven of which were endothelial. Excluding one case of trauma, all graft failures resulted from endothelial rejection. The probability of primary graft survival was 88% at 3 years and 74% at 5 years.


CONCLUSIONS
Regarding the difficulties in pediatric keratoplasty and the absence of a relationship between postoperative visual outcome and age at keratoplasty, a conservative approach and careful risk-benefit ratio evaluation are recommended in patients with CHED.
Javadi
Mohammad Ali
MA
Ophthalmic Research Center, Labbafinejad Medical Center, Shaheed Beheshti University of Medical Sciences, Tehran, Iran. ma_javadi@yahoo.com
Baradaran-Rafii
Ali Reza
AR
Zamani
Mitra
M
Karimian
Farid
F
Zare
Mohammad
M
Einollahi
Bahram
B
Jafarinasab
Mohammad Reza
MR
Yazdani
Shahin
S
D002648:Child; D002675:Child, Preschool; D003317:Corneal Dystrophies, Hereditary / Q000601:surgery*; D005260:Female; D006084:Graft Rejection; D006801:Humans; D015948:Keratoplasty, Penetrating; D008297:Male; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome; D014792:Visual Acuity