Indications and outcomes of pediatric penetrating keratoplasty: A retrospective observational study

Abstract Background: Pediatric corneal transplantation can be indicated in congenital and acquired conditions. Challenges include preoperative evaluation, multiple intraoperative obstacles, and postoperative problems in follow-up and management. This study was aimed at identifying the indications and clinical outcomes of pediatric penetrating keratoplasty (PKP) in Jordan. Methods: This retrospective cohort study was conducted in Amman, Jordan. Using the hospital’s electronic database, all medical records of patients aged < ۱۸ years who underwent PKP between January ۲۰۰۴ and October ۲۰۱۹ were reviewed. Preoperative evaluations included best-corrected distance visual acuity (BCDVA) and anterior and posterior segment examinations. Postoperative complications, BCDVA, and graft survival were examined ۱ year postoperatively. Results: A total of ۱۴۹ cases of pediatric PKP were performed on ۱۴۱ eyes of ۱۱۸ patients with an age mean ± standard deviation (SD) of ۱۱.۴۴ ± ۴.۹۷ years at the time of surgery. Acquired non-traumatic corneal pathologies accounted for ۶۵.۸% of indications for PKP. The most frequent indication was advanced keratoconus (۵۵.۷%). Preoperative and ۱-year postoperative BCDVAs significantly differed (P < ۰.۰۰۱), with ۱۱۱ (۷۴.۵%) patients showing improved BCDVA, ۱۲ (۸.۰۵%) patients showing worsened BCDVA, and ۲۶ (۱۷.۴۵%) patients showing no change in BCDVA. The overall ۱-year graft survival rate was ۸۰.۵۴%. Conclusions: This was the largest study in Jordan involving pediatric patients who underwent PKP for various indications, showing a significant improvement in BCDVA, with a high survival rate at ۱ year. Future studies with longer follow-up periods could provide stronger evidence for surgical outcomes and graft survival. Further, the option of lamellar keratoplasty in the pediatric age group should be assessed.