Analysis of Graft Failure After Primary Penetrating Keratoplasty in Children With Peters Anomaly

Abstract

Purpose: To investigate the causes of graft failure and risk factors associated with total graft opacity after primary penetrating keratoplasty (PK) in children with Peters anomaly (PA). Methods: In this retrospective study, patients with PA (younger than 5 years) who received primary PK in Beijing Tongren Hospital were reviewed. The follow-up period was a minimum of 6 months. A modified PA classification system was used, and all failed grafts were categorized into partial and total opacity groups. Patient demographics, PA classification, operation details, degree of graft opacity, and causes of graft failure were recorded. Results: Of the 165 eyes, 54 eyes (32.7%) demonstrated graft failure along with various degrees of graft opacity. Approximately half of the grafts applied failed within 6 months postoperatively. The partial and total opacity groups did not demonstrate any significant differences regarding diagnosis distribution. Irreversible immune rejection accounted for 61.1% of all graft failures; furthermore, it had a significantly higher proportion in the partial opacity group than in the total opacity group (71.0% and 47.8%, respectively; P = 0.058). The degree of graft opacity was significantly associated with patient age at surgery (P = 0.002), preoperative corneal vascularization (P = 0.009), and iris defects (P = 0.001). However, administration of intensive topical corticosteroids could reduce the risk of total opacity in the rejected grafts. Conclusions: Irreversible immune rejection is the most common cause of graft failure after primary PK in pediatric patients with PA. The degree of graft opacity is closely related to patient age at surgery, preoperative corneal vascularization, and iris defects.

Phenotypic Spectrum of Peters Anomaly: Implications for Management

“…We also show that fine vascularization of the central cornea is not uncommon with increasing frequency in severe type I and type II diseases (up to 50%). Of interest, Nischal 16 suggested the absence of corneal vessels as the hallmark of Peters anomaly type I disease, which is not consistent with our findings or with those of Sun et al 23 This shows the wide variability of ocular comorbidities that can coincide with Peters anomaly.…”

Selective Endothelialectomy in Peters Anomaly: A Novel Surgical Technique and Its Clinical Outcomes in Children

“…Several studies give importance to the anatomic and surgical results, and a small subset focuses exclusively on long-term functional outcomes of PK in children with PA. Supplementary Digital Content 3, http://links.lww.com/ICO/ B440, provides an overall comparison of this study's results with that of other large series consisting of different surgical interventions for PA. 2,8,[10][11][12]14,20,[31][32][33][34] We realized that PK had an inferior long-term outcome and merited stringent follow-up and had the risk of graft infection, allograft rejection, secondary glaucoma, suture-related issues, astigmatism, graft-host dehiscence, and reintervention if graft fails. 11 Because the inclusion criteria and definition of success vary across studies, superficial comparisons sometimes can lead to deeply flawed inferences.…”

“…[5][6][7] Bilateral disease is seen in 80% of PA, 5 and type 2 disease is more often associated with poor visual outcomes than type 1 disease. 2,5,[8][9][10][11][12][13][14] Anterior segment optical coherence tomography (AS-OCT) observation has shown a double-layered DM in PA, 15 explaining a reason for spontaneous closure of these defects. Histopathology of PA shows focal abnormal posterior corneal stromal architecture with focal absence of DM (Fig.…”

Selective endothelial removal: A case series of a phase I/II surgical trial with long-term follow up

“…Those with dense, large (>3 mm), centrally located corneal opacities require surgical interventions such as surgical iridectomy (6), fullthickness corneal transplantation (7) and/or lysis of iridocorneal and/or lenticulo-corneal adhesions (i.e., adhesiolysis) (8) to achieve clearance of the central visual axis. However, pediatric penetrating keratoplasty (PK) has been recognized as high-risk procedure because of the difficulties in pre-operative and post-operative assessment, low scleral rigidity and high vitreous pressure during operation, as well as increased fibrin reaction after the surgery (9). The visual outcomes after PK in Peters anomaly remain highly variable.…”