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  • Should Keratoplasty Be Delayed to Adulthood?

    By Lynda Seminara
    Selected By: Richard K. Parrish II, MD

    Journal Highlights

    American Journal of Ophthalmology, June 2021

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    Wajnsztajn et al. compared findings for children and adults who underwent penetrating or deep anterior lamellar keratoplasty for keratoconus. They found that the visual outcomes and rates of rejection-free and graft survival were comparable for children and adults, suggesting that the surgery need not be delayed for young patients.

    For this retrospective review, the authors gathered information from the U.K. Transplant Registry for children (defined as age 16 years or younger) and adults (defined as age 17 or older) who received their first transplant for keratoconus between 2003 and 2018. Main outcome measures were two-year visual, rejection-free, and graft survival data.

    Altogether, 7,361 initial corneal transplantations were performed during the study period; of these, 170 took place in children. Pre-op visual acuity (VA) of 20/200 or worse was more prevalent in children, as were rates of corneal vascularization and ocular surface disease. However, within two years of surgery, visual outcomes were comparable for the age groups: Best-corrected VA of 20/20 or better was achieved in 35% of children and 28% of adults. Rates of rejection and graft failure were marginally lower for children, but confidence intervals were wide. After penetrating keratoplasty,the endothelial rejection rate was slightly higher for children (13% vs. 10% for adults), but no child experi­enced irreversible rejection with either type of transplant. Despite the similar rejection rates, Cox regression analysis showed a statistically significant rela­tionship between patient age and graft rejection: For each five-year increase in age, the hazard of graft rejection decreased by 6%. Neither surgical pro­cedure was superior to the other for the outcomes explored.

    The authors concluded that there is no clear advantage to delaying kerato­plasty until adulthood. They acknowl­edged that most complications in children occur within a few months of transplantation and that VA is relatively stable from two to five years post-op.

    The original article can be found here.