title: Clinical results of 40 years of paediatric keratoplasty in a single university eye clinic.
abstract: OBJECTIVE
  To evaluate indications for paediatric keratoplasty in recipients aged ≤16 years and assess long-term clinical outcome.
  
  
  METHODS
  Recipients were identified from records of the Danish Cornea Bank. Data were collected from patient journals, clinical follow-up examinations and questionnaires and stratified into pre-, peri- and postoperative variables. Diagnoses were classified into acquired traumatic, acquired nontraumatic and congenital groups. Recipients were divided into groups of <8 and ≥8 years. Data were analyzed using relative percentages and Kaplan-Meier survival plots.
  
  
  RESULTS
  Thirty-three out of sixty identified recipients (73 keratoplasties in 63 eyes) were invited. Twenty-four accepted, seven still attended follow-up in our clinic. Follow-up data reached 95% of the eligible recipients (median follow-up 11 years). Twenty-three per cent were <8 years and 77%≤8 years. Diagnoses were mainly acquired nontraumatic (69%), acquired traumatic (12%) and congenital (7%). Indications were primarily optical (52%) or tectonic (41%). Graft survival was best in the acquired nontraumatic group (except regrafts) (median survival 15-20 years) and poorest in the regraft subgroup as well as the acquired traumatic and congenital groups (median survival 1-2 years). Graft failure was higher in the youngest with predisposing risk factors and in combined procedures. In terms of indications, visual improvement and eye preservation was achieved in 70%.
  
  
  CONCLUSIONS
  Paediatric keratoplasty was successful regarding indication. Graft survival was best in the acquired nontraumatic group and poorest in the congenital group. Vascularization and/or combined risk factors, additional surgeries and young recipient age influenced negatively on graft survival.
authors.affiliation: Department of Ophthalmology, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: Maria
authors.initials: M
authors.lastname: Hovlykke
authors.forename: Jesper
authors.initials: J
authors.lastname: Hjortdal
authors.forename: Niels
authors.initials: N
authors.lastname: Ehlers
authors.forename: Kim
authors.initials: K
authors.lastname: Nielsen
mesh_terms: D000293:Adolescent; D017677:Age Distribution; D002648:Child; D002675:Child, Preschool; D003316:Corneal Diseases / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery*; D003718:Denmark / Q000453:epidemiology; D005260:Female; D006085:Graft Survival / Q000502:physiology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015948:Keratoplasty, Penetrating; D008297:Male; D011183:Postoperative Complications; D012086:Reoperation; D012307:Risk Factors; D011795:Surveys and Questionnaires; D014792:Visual Acuity / Q000502:physiology
keywords: corneal transplant; diagnostic groups; graft survival; long-term outcome; paediatric keratoplasty; recipient age; risk factors; tectonic; visual outcome