Pediatric Keratoplasty: Indications, Techniques, and Long-term Outcomes

Purpose: To evaluate the indications and long-term clinical outcomes of patients aged 18 years and younger who underwent keratoplasty surgery. Methods: In this study, the medical records of 55 eyes from 43 patients younger than 18 years who underwent keratoplasty and were registered in the Atatürk University Faculty of Medicine Research Hospital between March 2014 and May 2024 were retrospectively reviewed. Pre-operative evaluations included corrected distance visual acuity (CDVA) and anterior and posterior segment examinations. Postoperative complications, CDVA, and graft survival status were assessed. Only patients with a minimum follow-up period of 1 year were included in the study. Results: The mean age of the patients was 14.1 years (range: 6 to 17 years), and the mean follow-up duration was 45 months (range: 12 to 124 months). Although 47 of the patients had penetrating keratoplasty (PKP), 8 had deep anterior lamellar keratoplasty (DALK). The most common indication was advanced keratoconus (60%). There was a statistically significant difference between preoperative and 1-year postoperative CDVA ( P < .001). Improvement in visual acuity was observed in 81.81% of patients. The overall graft survival rate was 92.73%. Conclusions: This study shows that keratoconus is the most common indication for keratoplasty in pediatric cases. The study demonstrates a high rate of improvement in graft survival and visual acuity in pediatric cases.