title: Primary pediatric keratoplasty: indications and outcomes.
abstract: OBJECTIVE
  To evaluate patient characteristics, indications, and outcomes of pediatric keratoplasty, and to identify variables that may help predict poor surgical outcomes.
  
  
  METHODS
  The authors performed a retrospective chart review of penetrating keratoplasty performed in children 14 years and younger between 1991 and 2006. Primary keratoplasty data were used in the statistical analysis for graft survival.
  
  
  RESULTS
  A total of 106 penetrating keratoplasties were performed in 47 patients during the study interval. Sixty procedures were primary grafts, and the remaining were regrafts. Median follow-up was 4.4 years. The surgical indications included congenital opacities in 37 eyes (61.6%), acquired nontraumatic opacities in 13 eyes (21.7%), and acquired traumatic opacities in 10 eyes (16.7%). Overall graft survival at 1 year was 54%. There was no statistically significant difference in 1 year graft survival among the surgical indication categories (congenital opacities 54%, acquired nontraumatic 53%, acquired traumatic 48%, P = 0.8). Graft survival at 1 year was similar among the different age groups (48% for patients younger than 6 months, 67% for patients 6 months to 5 years, 51% for patients older than 5 years, P = 0.78). Patients with Peters' anomaly had similar graft survival rates to patients with other congenital opacities (67% vs 48% survival at 1 year, P = 0.78) Patients with pretransplant and/or posttransplant glaucoma had worse 1-year graft survival compared with patients without preoperative glaucoma (glaucoma 32% vs no glaucoma 70%, P = 0.02) Pretransplant and/or posttransplant glaucoma was the only independent predictor of worse graft survival in a multivariate analysis (P = 0.02).
  
  
  CONCLUSIONS
  Pediatric penetrating keratoplasty has a fair overall prognosis for graft survival of approximately 50% at 1 year. Prekeratoplasty and/or postkeratoplasty glaucoma is associated with poorer long-term graft survival.
authors.affiliation: Department of Ophthalmology & Vision Science, University of California, Davis, Sacramento, CA 95817, USA.
authors.forename: Charles
authors.initials: C
authors.lastname: Huang
authors.forename: Mary
authors.initials: M
authors.lastname: O'Hara
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Mannis
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003315:Cornea / Q000473:pathology; D065306:Corneal Injuries; D003318:Corneal Opacity / Q000151:congenital / Q000175:diagnosis / Q000601:surgery*; D005131:Eye Injuries / Q000175:diagnosis / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D005901:Glaucoma / Q000151:congenital / Q000601:surgery; D020327:Glaucoma Drainage Implants; D006085:Graft Survival / Q000502:physiology; D006801:Humans; D007223:Infant; D015948:Keratoplasty, Penetrating; D008297:Male; D011379:Prognosis; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D013536:Suture Techniques; D014130:Trabeculectomy; D016896:Treatment Outcome