Purpose To describe the demographics, indications, clinical outcomes and survival rate of penetrating keratoplasty in Malaysian children living in a suburban area, and discuss the literature on paediatric penetrating keratoplasty. Methodology A retrospective review of medical records was performed on children younger than 17 years of age who had undergone penetrating keratoplasty in Hospital Universiti Sains Malaysia from January 2008 to December 2017. We recorded demographic data, presenting visual acuity, indications, final visual acuity, and graft survival at 12 months into the postoperative period. Results Sixteen eyes of 14 children had penetrating keratoplasty. Mean age was 7.8 ± 5.9 years. Both genders were equally affected. The main indications were infective keratitis (56.25%), congenital corneal opacity (18.75%) and trauma (12.50%). There were 62.50% of patients who had a preoperative visual acuity worse than 6/60. Fifty percent had other combined procedures during the surgery, including lens aspiration, peripheral iridectomy, pupilloplasty and glaucoma tube implant. Best corrected visual acuity of 6/12 or better was achieved in 18.75% of patients. A hazy graft was noted in 68.75% of patients, and was attributed to graft rejection, glaucoma and graft failure. There was a statistically significant association between the presence of vascularized cornea, intraocular inflammation and combined surgery with survival rate of the graft at one-year postoperative period (p < 0.05). Conclusions Infective keratitis is the main indication for penetrating keratoplasty in our pediatric patients. Good visual outcome was documented in a small percentage of the patients. Amblyopia and hazy graft were the main barriers to success in this group of patients. Vascularized cornea, inflammation and combined surgery had significantly affected the survival rate of the grafts in our series.
Retinal vasculitis is common in ocular toxoplasmosis (OT) and typically occurs in the same quadrant as retinochoroiditis. This is a case of atypical ocular toxoplasmosis with remote vasculitis distant from the retinochoroiditis lesion. Examination of the left fundus showed the classic posterior segment finding of "headlight in the fog" in the absence of a chorioretinal scar. Retinal vasculitis was noted in all four quadrants at the periphery far from the retinitis area. A presumptive diagnosis of acute panuveitis secondary to ocular toxoplasmosis was made despite the enzyme-linked immunosorbent assay (ELISA) for Toxoplasmosis antibody being pending. The patient was treated empirically with oral sulfamethoxazole-trimethoprim for eight weeks and received both oral and topical corticosteroids. His symptoms and ocular signs have significantly improved. This case report highlights an atypical remote localization of vasculitis with the classic appearance of retinochoroiditis and vitritis, which is highly due to toxoplasmosis. Early initiation of antibiotic therapy is recommended despite pending serology to ensure a good final visual and ocular outcome.