Penetrating keratoplasty in a newborn: case report and analysis of current surgical trends in Italy.
OBJECTIVE
The aims of this study were to describe bilateral penetrating keratoplasty (PK) in a newborn and to analyze the data of PKs performed in Italy during the 5-year period 1999-2003 in children under 4 years of age.


METHODS
A male newborn had PK at age 3 months and 5 months for near-blindness secondary to severe congenital corneal clouding in both eyes. The infant''s explanted corneas were subjected to histochemical and ultrastructural analyses. Data regarding the number of PKs performed in Italy on 0-4-year-olds were obtained from the Web site of the Italian Ministry of Health.


RESULTS
The postoperative courses were uncomplicated, and 42 months of follow-up data show bilateral graft transparency and substantial improvement in visual acuity despite high-grade myopia and nystagmus. At the ultrastructural level, the main alterations involved the endothelial cells and Descemet membrane. A total of 45 PKs were performed in Italy on patients 0-4 years old from 1999 through 2003; only nine involved babies under 1 year of age.


CONCLUSIONS
In babies with congenital corneal opacities, early PK can reduce severe amblyopia. However, the risk of intra- and postoperative complications in PK is high. Based on the 42-month follow-up, the anatomic and functional results achieved in the current patient are satisfactory despite the presence of nystagmus and postoperative high-grade myopia. This study shows that PKs are rarely performed, in Italy, in children aged 0-4 years, and very few are done during the first year of life.
Ricci
B
B
Ophthalmology Unit, Association Columbus Clinic, Catholic University, Roma, Italy. be.ricci@libero.it
Coppola
G
G
Capobianco
A
A
Ziccardi
L
L
D000293:Adolescent; D000550:Amblyopia / Q000517:prevention & control; D002675:Child, Preschool; D003318:Corneal Opacity / Q000151:congenital / Q000601:surgery*; D006801:Humans; D007223:Infant; D007431:Intraoperative Complications; D007558:Italy; D015948:Keratoplasty, Penetrating / Q000639:trends*; D008297:Male; D011183:Postoperative Complications; D014019:Tissue Donors