A 15-year experience with keratoplasty in the management of paediatric corneal diseases: indications and clinical outcomes in Malaysia

INTRODUCTION: Corneal blindness is a leading yet preventable cause of childhood blindness worldwide. Despite the need for corneal transplantation in paediatric cases, comprehensive data on its aetiology, clinical outcomes, and graft survival in Malaysia remain scarce. This study reviews the indications and outcomes of paediatric keratoplasty at Hospital Kuala Lumpur over the past 15 years.

MATERIALS AND METHODS: We conducted a retrospective evaluation of paediatric patients (less than 12-years-old) who underwent keratoplasty in Hospital Kuala Lumpur, from January 2008 to December 2022. We analysed demographic data, preoperative diagnoses, types of keratoplasty performed, and the 1-year graft survival rate.

RESULTS: 100 eyes from 95 patients were included in the study, with a mean age of 4.39 ±3.32 years. The indications for keratoplasty included limbal dermoid (45%), anterior segment dysgenesis/Peter's anomaly (22%), infective keratitis (14%), congenital glaucoma (4%), and other pathologies (15%). 31/100 (31%) had corneal perforation. Of the patients, 56% underwent lamellar keratoplasty (LK), while 44% underwent penetrating keratoplasty (PK). Complications included wound dehiscence (4%) and graft melting (3%). 77% completed 1-year follow-up, and the overall 1-year graft survival rate was 54.5%. Limbal dermoid showed a better graft survival rate (72.2%) compared to other pathologies (39%), with a p-value of 0.004. LK has a higher 1-year graft survival rate of 66% compared to PK (36.7%) with a p-value of 0.003. Among the cases of perforated corneas, an overall 1-year graft survival rate of 25.8% (8/31) was observed, which was significantly lower compared to eyes without corneal perforation 73.9% (34/46) with a p-value of 0.008.

CONCLUSIONS: Limbal dermoid was the most common indication for paediatric keratoplasty, and it exhibited a better graft survival rate compared to other pathologies. A one-year graft survival rate varies among different indications of keratoplasty. Perforated cornea has a lower graft survival rate compared to non-perforated corneal pathology.