Elsevier

Ophthalmology

Volume 106, Issue 4, 1 April 1999, Pages 829-832
Ophthalmology

Oversized grafts in children

Presented in part as a poster at the America Academy of Ophthalmology annual meeting, San Francisco, California, October 1997.
https://doi.org/10.1016/S0161-6420(99)90174-4Get rights and content

Abstract

Objective

To evaluate the efficacy of oversized corneal grafts in the pediatric age group.

Design

Prospective, nonrandomized clinical trial.

Participants and intervention

Forty pediatric patients with unilateral or bilateral corneal opacification of congenital or acquired origin underwent corneal grafting surgery over a period of 2 years using donor corneal buttons oversized by 1 mm.

Main outcome measures

The parameters evaluated were indications for keratoplasty, graft clarity, visual acuity, keratometry, spherical equivalent, anterior chamber depth, and complications.

Results

Corneal ulceration was the most common cause of corneal opacification (25%), followed by trauma (20%) and sclerocornea (20%). At 1 year, clear grafts were achieved in 85% of the cohort. The average keratometry at the end of 1 year was 43.28 ± 1.65 diopters (D) in the congenital opacity group and 43.04 ± 2.20 D in the acquired group. The keratometric astigmatism was 3.60 ± 2.60 D in the congenital group and 2.52 ± 2.20 D in the acquired group. Oversized grafts provided an adequate anterior chamber depth of 2.20 ± 0.612 mm in the congenital group and 2.36 ± 0.302 mm in the acquired group. Visual acuity of 20/80 or better was recorded in only 30% of cases in the congenital group as opposed to 47% with acquired opacities. Nine cases had episodes of graft rejection.

Conclusion

Oversizing donor buttons by 1 mm provides adequate anterior chamber depth and increases the morphologic success of corneal grafting in children.

Section snippets

Materials and methods

Forty consecutive patients, 12 years of age and younger, with bilateral or unilateral corneal opacity were enrolled for the study from the Cornea Service of our center. The inclusion factor was the presence of a corneal opacity with a shallow anterior chamber or corneoiridic scars.

Exclusion criteria included uncontrolled glaucoma, posterior segment pathology, and active corneal infection. Initial examination included a detailed record of the history, visual acuity testing, slit-lamp

Results

Of the 40 children enrolled in our study, 28 were males and 12 were females with an age range of 6 months to 12 years (Table 1). The mean age was 4.4 ± 4 years in the congenital opacity group and 6.3 ± 2.2 years in the acquired corneal scarring group. The major causes of corneal opacification were corneal ulceration (25%), trauma (20%), and sclerocornea (20%) (Table 2). Preoperative visual acuity was less than 20/200 in all cases. All eyes in the congenital group were phakic, while one eye in

Discussion

Corneal grafting in children has traditionally included the use of a 0.5-mm oversized donor corneal button, which was punched from the endothelial side. Despite optimal suturing, many of the pediatric patients developed shallow anterior chambers and anterior synechiae during the postoperative period. Corneoiridic scars and corneal opacification due to mesodermal dysgenesis were the major indications for surgery in such cases. Most of these cases had a shallow anterior chamber before surgery.

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