title: Outcomes of penetrating keratoplasty in mentally retarded patients with keratoconus.
abstract: OBJECTIVE
  Mentally retarded patients with keratoconus who underwent penetrating keratoplasty (PK) were reviewed to determine long-term graft survival outcome.
  
  
  METHODS
  This longitudinal retrospective study included 20 mentally retarded patients who underwent PK at the University Hospital of Alicante during the years 1978-2007. Variables included donor corneal study, type and level of mental retardation, demographic data, age at which PK was performed, preoperative ocular and corneal study, surgical technique, histopathologic study, complications, immunological graft rejection, mean suture permanency, corneal endothelium study, and final anatomic and visual outcome.
  
  
  RESULTS
  Thirty-nine penetrating keratoplasties were performed on 28 eyes of 20 patients. Mean age at time of surgery was 29.6 years (range 17-54 years). Follow-up ranged from 8 to 324 months, with a mean of 83.93 months. Vernal keratoconjunctivitis, cataract, and posterior capsular opacification were the most frequent complications during follow-up. Fifteen episodes of immunological graft rejection were registered. At the final examination, 23 grafts remain clear and 5 cloudy. Causes of corneal opacification were self-trauma, corneal ulceration, and immunological graft rejection. Four eyes developed ptisis bulbi.
  
  
  CONCLUSIONS
  PK is a safe procedure in mild and moderately mentally retarded patients without compulsive ocular patterns. In patients with associated eye rubbing or ocular self-trauma, the election has to be made individually and carefully assuming an additional risk of serious complications. Providing medical education to caregivers is essential for the correct management of these patients.
authors.affiliation: Department of Ophthalmology, Anterior Segment Division, University General Hospital of Alicante, Alicante, Spain. zemfira36@hotmail.com
authors.forename: Gerardo P
authors.initials: GP
authors.lastname: García García
authors.forename: José Belmonte
authors.initials: JB
authors.lastname: Martínez
mesh_terms: D000293:Adolescent; D000328:Adult; D002386:Cataract / Q000209:etiology; D003233:Conjunctivitis, Allergic / Q000209:etiology; D003320:Corneal Ulcer / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D008607:Intellectual Disability / Q000523:psychology; D007640:Keratoconus / Q000601:surgery*; D015948:Keratoplasty, Penetrating / Q000009:adverse effects / Q000276:immunology; D007903:Lens Capsule, Crystalline; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D019989:Persons with Intellectual Disabilities; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome; D055815:Young Adult