Pediatric PKP Graft Failure More Likely at Younger Ages


Among children who undergo penetrating keratoplasty (PKP), a type of corneal transplant, those who are older than 2 years at the time of surgery and those who do not undergo other eye procedures during the operation tend to have better outcomes, according to research presented at the American Academy of Ophthalmology (AAO) 2023 Annual Meeting.

PKP is considered riskier for children than adults because children typically have smaller eyes, less tissue rigidity, and robust inflammatory responses that can lead to complications, the study authors noted.


  • Researchers reviewed records for 73 children with corneal decompensation who underwent keratoplasty at one center between 2013 and 2022.

  • They focused on 49 eyes for which there was at least 6 months of follow-up.

  • The average age of the patients was 6 years (range, 11 days to 16.93 years).

  • Among all patients, 59% had congenital indications, 33% had acquired nontraumatic indications, and 8% had traumatic indications.


  • Graft failure occurred in 31 eyes (63%).

  • The graft survival rate was 63.2% at 6 months, 53.1% at 1 year, 49% at 2 years, and 40.8% at 5 years.

  • Graft survival was better for patients older than 2 years at the time of surgery (P = .0143) and for those who underwent a single procedure rather than a combination of procedures, such as PKP with retinal detachment repair or lensectomy (P = .0043).


The findings may aid surgical planning and “help to identify some factors that are associated with greater long-term success,” study author Shivani P. Majmudar, a medical student at University of Illinois Chicago, told Medscape Medical News.


Majmudar conducted the research with Maria S. Cortina, MD, and Priyanka Chhadva, MD. The study was presented in a poster at the American Academy of Ophthalmology (AAO) 2023 Annual Meeting.


The investigators relied on retrospective data from a relatively small number of patients.


The authors disclosed no conflicts of interest.

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