Eye Bank Records on Pediatric Keratoplasty

Abstract

Purpose: To report eye bank records for pediatric keratoplasty in Iran between 2006 and 2019.

Methods: In a retrospective study, all electronic records of the Central Eye Bank of Iran for pediatric keratoplasty between April 2006 and March 2019 were analyzed in terms of indications for keratoplasty, surgical techniques, their corresponding trends, and post-transplantation graft clarity.

Results: Our database included 2178 eyes from 2050 pediatric cases. The leading indications for keratoplasty included acquired nontraumatic diseases (75.8%), congenital abnormalities (12.7%), corneal regraft (8.3%), and acquired traumatic diseases (3.2%). Keratoconus was the most common acquired nontraumatic cause (58%) and more common in the age group $>$ 12 years than those $\le$ 12 years (P $<$ 0.001). Congenital corneal abnormalities and regrafts were more common in the age group $\le$ 12 years (both P $<$ 0.001). The most common surgical technique was penetrating keratoplasty (PKP, 90.9%) followed by deep anterior lamellar keratoplasty (DALK, 7.3%), Descemet stripping automated endothelial keratoplasty (DSAEK, 1.1%), anterior lamellar keratoplasty (0.5%), and keratolimbal allograft transplantation (0.2%). DSAEK was more common in the age group $\le$ 12 years (P = 0.002), which, unlike PKP and DALK, showed a significant ascending trend over the 14-year period (P = 0.018). Post-transplantation graft clarity was 96.8%.

Conclusion: Keratoconus was the leading indication for pediatric keratoplasty in Iran. Although PKP was the predominant keratoplasty procedure for the treatment of pediatric corneal disorders, it showed a significant descending trend over the 14 years.

Keywords: Descemet Membrane Stripping Automated Endothelial Keratoplasty; Keratoconus; Pediatric Keratoplasty; Penetrating Keratoplasty; Deep Anterior Lamellar Keratoplasty.

Figure 1

Trends of indications for pediatric keratoplasty between 2006 and 2019. Note the significant falling trend for acquired non-traumatic diseases (a; P $<$ 0.001); congenital abnormalities (b; P = 0.014), and acquired traumatic diseases (c; P = 0.021). No significant change of trend is observed for the regraft over the 14-year period (d; P = 0.69).

Figure 2

Trends of the indications for pediatric keratoplasty in each main category in Iran between 2006 and 2019. Note the significant declining trend for keratoconus (a; P $<$ 0.001); bullous keratopathies (b; P = 0.002); corneal infections (d; P = 0.043); corneal dystrophies (f; P = 0.036); and chemical injuries (i; P = 0.036). No significant change of trend is noted for non-specified corneal opacities (c; P = 0.173), corneal degenerations (e; P = 0.341), congenital corneal opacities (g; P = 0.073), and mechanical injuries (h; P = 0.07) over the 14-year period.

Figure 3

Trends of surgical techniques for pediatric keratoplasty in Iran between 2006 and 2019. Note the significant downward trend for PKP (a; P $<$ 0.001) and DALK (b; P = 0.018); the remarkable ascending trend for DSAEK (c; P = 0.018); the borderline change of trend for the ALK (d; P = 0.068), and the lack of change of trend for KLAL (e; P = 0.278). PKP, penetrating keratoplasty; DALK, deep anterior lamellar keratoplasty; DSAEK, Descemet stripping automated endothelial keratoplasty; ALK, anterior lamellar keratoplasty; KLAL, keratolimbal allograft.

Figure 4

The proportion of indications for each surgical procedure. Keratoconus was the leading indication for PKP (41.3%) and DALK (87.4%), while corneal dystrophies were the main cause for DSAEK (54.2%) and ALK (70%). KLAL technique was exclusively used for chemical injuries (100%). PKP, penetrating keratoplasty; DALK, deep anterior lamellar keratoplasty; DSAEK, Descemet stripping automated endothelial keratoplasty; ALK, anterior lamellar keratoplasty; KLAL, keratolimbal allograft.