Predicting of penetrating keratoplasty outcome in children

Abstract

Purpose of the study: to analyze risk factors affecting the outcome of penetrating keratoplasty (PK) in children. Material and methods. We retrospectively and prospectively analyzed the medical records and outpatient charts of children undergoing surgery at the Pediatric Eye Pathology Department of the Helmholtz National Medical Research Center of Eye Diseases between 2000 and 2024. Cases were selected that met the following criteria: a) PK was performed; b) non-preserved donor material was used; c) the patient was 14 years or younger at the time of transplantation; d) the graft was followed for at least 3 months postoperatively. The sample size consisted of 236 cases of PK performed in 222 children (236 eyes). Risk factors affecting graft survival and functionality were assessed. Results. A significant impact of patient age on the outcome of corneal transplantation was revealed: in younger children, the outcome is often more favorable, which is associated with high tissue plasticity and less severe immunological reactions. The presence of comorbidities significantly worsens the prognosis and increases the risk of graft rejection. The quality of the donor material and adherence to postoperative care rules, which help reduce the risk of corneal opacity, are also important factors. Conclusion. Predicting the outcome of corneal transplantation is usually hypothetical and subjective, based primarily on the surgeon’s personal experience and intuition. Identifying risk factors in corneal transplantation allows us to identify those factors that critically affect the outcome of the surgery within the diversity of clinical presentations; their quantitative assessment allows us to present a prognosis in terms of statistically verified probability.