title: [Keratoplasty in Children and Adolescents].
abstract: BACKGROUND
  The conditions for long-term graft survival in infants and children are unfavorable, due to the different immunological features, the impaired clinical examination and the reduced compliance and treatment adherence. However, penetrating keratoplasty is often the only option to prevent amblyopia and there may be no alternative. We examined the different indications, graft survival and complications in two specialised centres.
  
  
  METHODS
  We identified all patients who were under the age of 18 years at the time of their penetrating keratoplasty. We then assessed the electronic file on indications, graft failure, visual acuity, enucleation and further complications.
  
  
  RESULTS
  A total of 104 eyes of 95 patients (54 % female) were identified. Median age at the time of surgery was 14 years (quartiles 8 and 16 years). Median follow-up was 2.7 years. The following indications were identified: keratoconus (39 %), penetrating injury (18 %), non-herpetic corneal scars (12 %), herpetic corneal scars (6 %), sclerocornea (3 %), chemical burn (3 %) and miscellaneous indications (19 %). Clear graft survival according to the Kaplan-Meier method ranged from 100 % (keratoconus) to 35 % (sclerocornea). Enucleation was only necessary in patients with penetrating injuries (n = 2). Kaplan-Meier analysis estimated the failure of all grafts after one year in infants. In older patients, 90 % of grafts were still clear at that time.
  
  
  CONCLUSIONS
  Prognosis of penetrating keratoplasty in children is related to the indication, and therefore the underlying disease, as well as the patients' age. In particular, infants exhibited poor prognosis, with only a very short period of clear graft survival. In indications, keratoconus showed the best prognosis, whereas sclerocornea and penetrating injuries had the worst prognosis.
authors.affiliation: Klinik für Augenheilkunde, Universitätsklinikum Freiburg.
authors.forename: S J
authors.initials: SJ
authors.lastname: Lang
authors.affiliation: Klinik für Augenheilkunde, Universitätsklinikum Freiburg.|Augenarztpraxis Dres. Richter, Waldkirch.
authors.forename: C
authors.initials: C
authors.lastname: Richter
authors.affiliation: Augenarztpraxis Dres. Richter, Waldkirch.|Klinik für Augenheilkunde, Universitätsklinikum Düsseldorf.
authors.forename: O
authors.initials: O
authors.lastname: Richter
authors.affiliation: Klinik für Augenheilkunde, Universitätsklinikum Freiburg.
authors.forename: D
authors.initials: D
authors.lastname: Böhringer
authors.affiliation: Klinik für Augenheilkunde, Universitätsklinikum Düsseldorf.
authors.forename: G
authors.initials: G
authors.lastname: Geerling
authors.affiliation: Klinik für Augenheilkunde, Universitätsklinikum Freiburg.
authors.forename: T
authors.initials: T
authors.lastname: Reinhard
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D015353:Eye Enucleation; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy; D006085:Graft Survival / Q000502:physiology; D006801:Humans; D007223:Infant; D053208:Kaplan-Meier Estimate; D015948:Keratoplasty, Penetrating / Q000379:methods*; D008297:Male; D010349:Patient Compliance; D011183:Postoperative Complications / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy; D055031:Primary Graft Dysfunction / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy; D014792:Visual Acuity / Q000502:physiology