关键词: 儿童角膜移植, 穿透性角膜移植, 先天性角膜白斑, 排斥反应

Abstract:

Objective To describe the etiology， and results of corneal graft after penetrating keratoplasty(PKP) in infants and young children, and to identify the risk factors for graft failure. Design Retrospective case series. Participants Eighty-one children (81 eyes) aged below 12 years old who underwent PKP in Beijing Tongren Hospital between January 2008 and December 2013. Method Eighty-one children were divided into two groups: infant group (≤3 years old) and young children group (>3 years ，≤12years old). All patients underwent PKP surgery. Mean follow-up time was 38.72±21.46 months. Main Outcome Measure Characteristics of the age, etiology, and the surgical procedure, graft clarity. Results The most common etiology for children PKP surgery included congenital corneal opacity 82.72%, acquired traumatic 6.17% and acquired nontraumatic 11.11%(infectious keratitis 3.70%, keratoconus 3.70%， graft failure 3.70%). There were significant difference in  the  etiology of  congenital corneal opacity between infant group(93.88%) and young children group(65.63%) (P<0.01). The rate of PKP is 80.25%. There were difference in rate of merely PKP between infant group 89.80%（44/49）and young children group 75.00%（24/32）(P<0.05). The overall probability of maintaining a clear graft was 85.19% (69/81) at the last follow-up (infant group 81.63%, and young children group 90.63%, P>0.05). The rejection for congenital corneal opacity and sclerocornea was 12.31%. Eyes with the indications of corneal ulceration leading to perforation and graft rejection had significantly poor outcomes after the PKP. Conclusions The most common indications of PKP surgery for children under 12 years old was congenital corneal opacity.  Although PKP is difficult in children, it has a reasonable chance of success. However, the anatomic success of PKP is increasing. (Ophthalmol CHN, 2015, 26: 262-266)

Key words: pediatric keratoplasty, penetrating keratoplasty; , congenital corneal opacity, rejection