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Abstract：
OBJECTIVE: To evaluate the graft rejection and visual outcomes after penetrating keratoplasty (PK) in the presence of various congenital corneal opacities in children.
METHODS: In this retrospective cohort study, children who underwent PK were then followed for 5y. The patient\'s medical records were collected from June 2014 until June 2019 and analyzed in December 2019. All patients were children under three years old with congenital corneal opacities with or without microcornea who came to a pediatric ophthalmologist and underwent PK in Jakarta Eye Center (JEC). Beforehand, all children have participated in a thorough evaluation for PK. In the case of severe microcornea was not advised to undergo surgery. The visual outcomes and graft survival rate were described in percentages. The graft survival plot was presented with Kaplan-Meier, while the visual acuity was analyzed using the Wilcoxon signed ranks test.
RESULTS: Sixteen eyes from eleven patients (seven girls and four boys) underwent PK. The graft survival rate of the first 6, 12, and 18 mo later of keratoplasty was 100%, 83.3%, and 66.7%, respectively. The overall mean survival time is 22mo (standard error 2.419), and no significant difference between the patients underwent PK before and after 36mo of their age (P=0.52). The graft failure was 50%, and post-surgery complications included cataract 43.7%, band keratopathy 12.5%, and scleromalasia 6.25%. Wilcoxon test analysis of visual acuity post keratoplasty was not statistically significant (P=0.34), while overall showed 44% improvements of visual outcome for 5y of follow-up. With a good survival at one year up to 22mo (83.3%), the visual acuity could be achieved (63%), and showed improvements (44%) during follow-up.
CONCLUSIONS: The complications are frequent for pediatric PK. Thus, corneal surgery on infants requires careful case selection, adequate pre-operative evaluation, skilled surgery (optical correction), very close cooperation family-physician, intensive post-operation care, and amblyopia management in the future.
METHODS: In this retrospective cohort study, children who underwent PK were then followed for 5y. The patient\'s medical records were collected from June 2014 until June 2019 and analyzed in December 2019. All patients were children under three years old with congenital corneal opacities with or without microcornea who came to a pediatric ophthalmologist and underwent PK in Jakarta Eye Center (JEC). Beforehand, all children have participated in a thorough evaluation for PK. In the case of severe microcornea was not advised to undergo surgery. The visual outcomes and graft survival rate were described in percentages. The graft survival plot was presented with Kaplan-Meier, while the visual acuity was analyzed using the Wilcoxon signed ranks test.
RESULTS: Sixteen eyes from eleven patients (seven girls and four boys) underwent PK. The graft survival rate of the first 6, 12, and 18 mo later of keratoplasty was 100%, 83.3%, and 66.7%, respectively. The overall mean survival time is 22mo (standard error 2.419), and no significant difference between the patients underwent PK before and after 36mo of their age (P=0.52). The graft failure was 50%, and post-surgery complications included cataract 43.7%, band keratopathy 12.5%, and scleromalasia 6.25%. Wilcoxon test analysis of visual acuity post keratoplasty was not statistically significant (P=0.34), while overall showed 44% improvements of visual outcome for 5y of follow-up. With a good survival at one year up to 22mo (83.3%), the visual acuity could be achieved (63%), and showed improvements (44%) during follow-up.
CONCLUSIONS: The complications are frequent for pediatric PK. Thus, corneal surgery on infants requires careful case selection, adequate pre-operative evaluation, skilled surgery (optical correction), very close cooperation family-physician, intensive post-operation care, and amblyopia management in the future.
摘要：
目的：评估儿童存在各种先天性角膜混浊的穿透性角膜移植术（PK）后的移植物排斥反应和视觉结果。
方法：在这项回顾性队列研究中，接受PK的儿童随后随访5y.从2014年6月至2019年6月收集患者的病历，并于2019年12月进行分析。所有患者均为三岁以下患有先天性角膜混浊的儿童，有或没有微角膜，他们来到儿科眼科医生并在雅加达眼科中心（JEC）接受了PK。事先，所有儿童都参加了PK的全面评估。在严重的情况下，不建议微角膜接受手术。以百分比描述视觉结果和移植物存活率。移植物存活图呈现为Kaplan-Meier，而视力使用Wilcoxon符号等级检验进行分析。
结果：11例患者（7名女孩和4名男孩）的16只眼进行了PK。角膜移植术后的前6、12和18个月的移植物存活率为100％，83.3%,和66.7%，分别。总平均生存时间为22mo（标准误差2.419），在年龄36mo之前和之后进行PK的患者之间没有显着差异（P=0.52）。移植失败50%,术后并发症包括白内障43.7%，带状角膜病变12.5%，和scleromalasia6.25%。Wilcoxon检验分析角膜移植术后视力无统计学意义(P=0.34),而在5年的随访中，总体上显示视觉结局改善了44%。在一年至22个月（83.3％）的良好生存，视力可以达到(63%)，并在随访期间显示改善(44%)。
结论：小儿PK的并发症很常见。因此，婴儿角膜手术需要仔细选择病例，充分的术前评估，熟练的手术（光学矫正），家庭医生密切合作，术后强化护理,和弱视管理的未来。
方法：在这项回顾性队列研究中，接受PK的儿童随后随访5y.从2014年6月至2019年6月收集患者的病历，并于2019年12月进行分析。所有患者均为三岁以下患有先天性角膜混浊的儿童，有或没有微角膜，他们来到儿科眼科医生并在雅加达眼科中心（JEC）接受了PK。事先，所有儿童都参加了PK的全面评估。在严重的情况下，不建议微角膜接受手术。以百分比描述视觉结果和移植物存活率。移植物存活图呈现为Kaplan-Meier，而视力使用Wilcoxon符号等级检验进行分析。
结果：11例患者（7名女孩和4名男孩）的16只眼进行了PK。角膜移植术后的前6、12和18个月的移植物存活率为100％，83.3%,和66.7%，分别。总平均生存时间为22mo（标准误差2.419），在年龄36mo之前和之后进行PK的患者之间没有显着差异（P=0.52）。移植失败50%,术后并发症包括白内障43.7%，带状角膜病变12.5%，和scleromalasia6.25%。Wilcoxon检验分析角膜移植术后视力无统计学意义(P=0.34),而在5年的随访中，总体上显示视觉结局改善了44%。在一年至22个月（83.3％）的良好生存，视力可以达到(63%)，并在随访期间显示改善(44%)。
结论：小儿PK的并发症很常见。因此，婴儿角膜手术需要仔细选择病例，充分的术前评估，熟练的手术（光学矫正），家庭医生密切合作，术后强化护理,和弱视管理的未来。
