Abstract: Objective To study the factors affecting the prognosis of children with congenital corneal leukoplakia after corneal penetrating keratoplasty. Design Retrospective case series. Participants 63 children (63 eyes) with congenital corneal leukoplakia who underwent penetrating keratoplasty at Peking University Eye Center from 2018 to 2020. Methods The electronic medical records of children were evaluated retrospective, including gender, age, corneal disease type, diagnosis and treatment history, postoperative complications and so on. A binary multivariate Logistic regression analysis was performed on the survival rate of corneal grafts at 24 months after surgery to explore the factors affecting the prognosis, and survival curves were plotted. Main Outcome Measures Postoperative complications and survival time of corneal grafts. Results The average age of the children who underwent penetrating keratoplasty was （11.71±10.44） months (3~55 months). The 2-year survival rate of the grafts after surgery was 61.9%. Logistic regression analysis showed that persistentcorneal epithelial defects(P=0.048), immune rejection(P=0.002) and postoperative high intraocular pressure (IOP) (P=0.030) were the main factors leading to failure. Persistent corneal epithelial defects occured one week after surgery, and had not fully healed after using medication for more than one month. Immune rejection and high IOP mainly occured between 1 to 6 months after surgery. After the occurrence of persistent corneal epithelial defects, the survival rate of corneal grafts was 33.33% and 22.22% at 1 and 2 years after surgery. After immune rejection, the survival rate of corneal grafts was 22.22% and 11.11% at 1 and 2 years after surgery. After the occurrence of high IOP, the survival rate of corneal grafts was 45.45% and 18.18% at 1 and 2 years after surgery. All of them were significantly lower than the 97.44% (P<0.001) and 87.18% (P<0.001), which were the survival rate of corneal grafts of children without major complications. Conclusion The factors affecting the prognosis of children with congenital corneal leukoplakia after corneal penetrating keratoplasty are immune rejection, high IOP, and corneal epithelial defects.

Key words: Congenital corneal leukoplakia, Penetrating keratoplasty, Children