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. 1997 Dec;81(12):1064–1069. doi: 10.1136/bjo.81.12.1064

Transplantation of congenitally opaque corneas

B Frueh 1, S Brown 1
PMCID: PMC1722090  PMID: 9497466

Abstract

AIMS—To assess retrospectively the prognosis and complications of corneal grafting for congenital opacities.
METHODS—Fifty eight eyes of infants and young children with congenital corneal opacities were studied retrospectively. Preoperative diagnoses included sclerocornea (27 eyes), Peters' anomaly (17 eyes), partial sclerocornea (12 eyes), and congenital glaucoma (two eyes). Penetrating keratoplasty was performed between 5 days and 65 months of age with a mean follow up of 40 (SD 29) months.
RESULTS—The overall success (including regrafts) was 70% in eyes with sclerocornea, 83% for partial sclerocornea, and 100% for Peters' anomaly. However, 23 eyes had to be regrafted between 2 weeks and 110 months postoperatively. The probability of maintaining a clear graft, calculated by survival analysis, was 75% (SE 6%) at 1 year and 58% (7%) at 2 years for the entire group. Complications included cataract development (12 eyes), secondary glaucoma (14 eyes), epithelial defects (six eyes), band keratopathy (five eyes), retinal detachment (three eyes), wound leakage (two eyes), retrocorneal membrane (one eye), and microbial keratitis (two eyes).
CONCLUSIONS—It is concluded that corneal grafting for congenital opacities in infants has an excellent potential for long term survival and should be performed as early as possible for unilateral as well as bilateral involvement. The postoperative course is complex and often requires regrafting.



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Figure 1  .

Figure 1  

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Kaplan-Meier survival curves of graft survival for the first, second, and third penetrating keratoplasty. The symbols represent end of follow up.

Figure 2  .

Figure 2  

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Kaplan-Meier survival curves for the first grafts, presented by different diagnostic groups. Congenital glaucoma (two eyes) have been excluded.

Figure 3  .

Figure 3  

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Kaplan-Meier survival curves of grafts with and without lensectomy and anterior vitrectomy at first surgery. Mantel-Haenszel approach showed a significant difference in graft survival between the two groups (p=0.018).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Astle W. F., Lin D. T., Douglas G. R. Bilateral penetrating keratoplasty and placement of a Molteno implant in a newborn with Peters' anomaly. Can J Ophthalmol. 1993 Oct;28(6):276–282. [PubMed] [Google Scholar]
  2. Beauchamp G. R. Pediatric keratoplasty: problems in management. J Pediatr Ophthalmol Strabismus. 1979 Nov-Dec;16(6):388–394. doi: 10.3928/0191-3913-19791101-13. [DOI] [PubMed] [Google Scholar]
  3. Brown S. I. Corneal transplantation in the anterior chamber cleavage syndrome. Am J Ophthalmol. 1970 Dec;70(6):942–944. doi: 10.1016/0002-9394(70)92471-2. [DOI] [PubMed] [Google Scholar]
  4. Brown S. I., Salamon S. M. Wound healing of grafts in congenitally opaque infant corneas. Am J Ophthalmol. 1983 May;95(5):641–644. doi: 10.1016/0002-9394(83)90383-5. [DOI] [PubMed] [Google Scholar]
  5. Cameron J. A. Good visual result following early penetrating keratoplasty for Peters' anomaly. J Pediatr Ophthalmol Strabismus. 1993 Mar-Apr;30(2):109–112. doi: 10.3928/0191-3913-19930301-11. [DOI] [PubMed] [Google Scholar]
  6. Cowden J. W. Penetrating keratoplasty in infants and children. Ophthalmology. 1990 Mar;97(3):324–329. doi: 10.1016/s0161-6420(90)32586-1. [DOI] [PubMed] [Google Scholar]
  7. Dana M. R., Moyes A. L., Gomes J. A., Rosheim K. M., Schaumberg D. A., Laibson P. R., Holland E. J., Sugar A., Sugar J. The indications for and outcome in pediatric keratoplasty. A multicenter study. Ophthalmology. 1995 Aug;102(8):1129–1138. doi: 10.1016/s0161-6420(95)30900-1. [DOI] [PubMed] [Google Scholar]
  8. Erlich C. M., Rootman D. S., Morin J. D. Corneal transplantation in infants, children and young adults: experience of the Toronto Hospital for Sick Children, 1979-88. Can J Ophthalmol. 1991 Jun;26(4):206–210. [PubMed] [Google Scholar]
  9. Feldman S. T., Frucht-Pery J., Brown S. I. Corneal transplantation in microphthalmic eyes. Am J Ophthalmol. 1987 Aug 15;104(2):164–167. doi: 10.1016/0002-9394(87)90009-2. [DOI] [PubMed] [Google Scholar]
  10. Frucht-Pery J., Feldman S. T., Brown S. I. Transplantation of congenitally opaque corneas from eyes with exaggerated buphthalmos. Am J Ophthalmol. 1989 Jun 15;107(6):655–658. doi: 10.1016/0002-9394(89)90263-8. [DOI] [PubMed] [Google Scholar]
  11. GOLDSTEIN J. E., COGAN D. G. Sclerocornea and associated congenital anomalies. Arch Ophthalmol. 1962 Jun;67:761–768. doi: 10.1001/archopht.1962.00960020761011. [DOI] [PubMed] [Google Scholar]
  12. Gordon Y. J., Mokete M. Penetrating keratoplasty in children. J Pediatr Ophthalmol Strabismus. 1979 Sep-Oct;16(5):297–300. doi: 10.3928/0191-3913-19790901-07. [DOI] [PubMed] [Google Scholar]
  13. Gregg F. M., Parks M. M. Stereopsis after congenital monocular cataract extraction. Am J Ophthalmol. 1992 Sep 15;114(3):314–317. doi: 10.1016/s0002-9394(14)71797-0. [DOI] [PubMed] [Google Scholar]
  14. Heon E., Barsoum-Homsy M., Cevrette L., Jacob J. L., Milot J., Polemeno R., Musarella M. A. Peters' anomaly. The spectrum of associated ocular and systemic malformations. Ophthalmic Paediatr Genet. 1992 Jun;13(2):137–143. doi: 10.3109/13816819209087614. [DOI] [PubMed] [Google Scholar]
  15. Iverson D. A., Katsura H., Hartzer M. K., Blumenkranz M. S. Inhibition of intraocular fibrin formation following infusion of low-molecular-weight heparin during vitrectomy. Arch Ophthalmol. 1991 Mar;109(3):405–409. doi: 10.1001/archopht.1991.01080030107048. [DOI] [PubMed] [Google Scholar]
  16. Johnson R. N., Balyeat E., Stern W. H. Heparin prophylaxis for intraocular fibrin. Ophthalmology. 1987 Jun;94(6):597–601. doi: 10.1016/s0161-6420(87)33403-7. [DOI] [PubMed] [Google Scholar]
  17. Johnson R. N., Blankenship G. A prospective, randomized, clinical trial of heparin therapy for postoperative intraocular fibrin. Ophthalmology. 1988 Mar;95(3):312–317. doi: 10.1016/s0161-6420(88)33181-7. [DOI] [PubMed] [Google Scholar]
  18. Kivlin J. D., Fineman R. M., Crandall A. S., Olson R. J. Peters' anomaly as a consequence of genetic and nongenetic syndromes. Arch Ophthalmol. 1986 Jan;104(1):61–64. doi: 10.1001/archopht.1986.01050130071022. [DOI] [PubMed] [Google Scholar]
  19. Legeais J. M., Jobin D., Pouliquen Y. Kératoplasties chez l'enfant. Analyse sur 10 ans de 127 yeux opérés. J Fr Ophtalmol. 1990;13(3):116–120. [PubMed] [Google Scholar]
  20. MANTEL N., HAENSZEL W. Statistical aspects of the analysis of data from retrospective studies of disease. J Natl Cancer Inst. 1959 Apr;22(4):719–748. [PubMed] [Google Scholar]
  21. Mayer U. M. Peters' anomaly and combination with other malformations (series of 16 patients). Ophthalmic Paediatr Genet. 1992 Jun;13(2):131–135. doi: 10.3109/13816819209087613. [DOI] [PubMed] [Google Scholar]
  22. Moriarty A. P., Kerr-Muir M. G. Sclerocornea and interstitial deletion of the short arm of chromosome 6--(46XY del[6] [p22 p24]). J Pediatr Ophthalmol Strabismus. 1992 May-Jun;29(3):177–179. doi: 10.3928/0191-3913-19920501-12. [DOI] [PubMed] [Google Scholar]
  23. Parmley V. C., Stonecipher K. G., Rowsey J. J. Peters' anomaly: a review of 26 penetrating keratoplasties in infants. Ophthalmic Surg. 1993 Jan;24(1):31–35. [PubMed] [Google Scholar]
  24. Schanzlin D. J., Goldberg D. B., Brown S. I. Transplantation of congenitally opaque corneas. Ophthalmology. 1980 Dec;87(12):1253–1264. doi: 10.1016/s0161-6420(80)35100-2. [DOI] [PubMed] [Google Scholar]
  25. Schönherr U., Küchle M., Lang G. K., Naumann G. O. Keratoplastik im Kindesalter. Bericht über 71 Keratoplastiken. Klin Monbl Augenheilkd. 1993 Sep;203(3):167–173. doi: 10.1055/s-2008-1045663. [DOI] [PubMed] [Google Scholar]
  26. Stulting R. D., Sumers K. D., Cavanagh H. D., Waring G. O., 3rd, Gammon J. A. Penetrating keratoplasty in children. Ophthalmology. 1984 Oct;91(10):1222–1230. doi: 10.1016/s0161-6420(84)34171-9. [DOI] [PubMed] [Google Scholar]
  27. Waring G. O., 3rd, Laibson P. R. Keratoplasty in infants and children. Trans Sect Ophthalmol Am Acad Ophthalmol Otolaryngol. 1977 Mar-Apr;83(2):283–296. [PubMed] [Google Scholar]
  28. Wood T. O., Kaufman H. E. Penetrating keratoplasty in an infant with sclerocornea. Am J Ophthalmol. 1970 Oct;70(4):609–613. doi: 10.1016/0002-9394(70)90897-4. [DOI] [PubMed] [Google Scholar]
  29. van Schooneveld M. J., Delleman J. W., Beemer F. A., Bleeker-Wagemakers E. M. Peters'-plus: a new syndrome. Ophthalmic Paediatr Genet. 1984 Dec;4(3):141–145. doi: 10.3109/13816818409006113. [DOI] [PubMed] [Google Scholar]

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