title: Long-term graft survival in patients with Down syndrome after penetrating keratoplasty.
abstract: OBJECTIVE
  To determine graft survival and long-term visual outcome after penetrating keratoplasty (PK) for keratoconus in patients with Down syndrome.
  
  
  METHODS
  The records of all patients with Down syndrome who received PK by the same provider were reviewed. A retrospective analysis was performed to determine long-term graft survival, incidence of graft failure, and complication rate.
  
  
  RESULTS
  Twenty-one PKs were performed on 18 eyes of 13 patients with Down syndrome with keratoconus. Three repeat PKs were performed for secondary graft failure. All 18 eyes had clear grafts at the most recent examination. Follow-up ranged from 4 to 88 months, with a mean of 34.9 months. The average age of patients was 42 years, with a range of 20 to 63 years. Preoperative visual acuity ranged from 20/160 to count fingers. Postoperatively, visual acuity was objectively measurable in 12 eyes of 8 patients and ranged from 20/30 to 20/200, with a mean of 20/60. Broken sutures and difficulties with unsedated suture removal complicated postoperative care in some patients.
  
  
  CONCLUSIONS
  Clear grafts and improvements in visual acuity can be obtained after PK in patients with Down syndrome, but consideration must be given to careful postoperative care by health care providers and home support personnel.
authors.affiliation: Ophthalmology Service, Madigan Army Medical Center, Tacoma, WA, USA. Keith.Wroblewski@NA.AMEDD.ARMY.MIL
authors.forename: Keith J
authors.initials: KJ
authors.lastname: Wroblewski
authors.forename: Thomas H
authors.initials: TH
authors.lastname: Mader
authors.forename: Mark F
authors.initials: MF
authors.lastname: Torres
authors.forename: Vernon C
authors.initials: VC
authors.lastname: Parmley
authors.forename: Walter M
authors.initials: WM
authors.lastname: Rotkis
mesh_terms: D000328:Adult; D003315:Cornea / Q000502:physiology*; D004314:Down Syndrome / Q000150:complications*; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival / Q000502:physiology*; D006801:Humans; D007640:Keratoconus / Q000150:complications / Q000601:surgery*; D015948:Keratoplasty, Penetrating; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care / Q000379:methods; D012189:Retrospective Studies; D014792:Visual Acuity / Q000502:physiology