Background: Keratoplasty is a routine method in adults but there are some additional problems in children. These include difficulties in examining the patients, amblyopia and an increased rate of graft rejection.
Patients and methods: Between 1980 and 1990 71 keratoplasties in 66 eyes of 61 patients under 16 years of age were performed. The indications and results were studied retrospectively and since 1987 prospectively. The average follow-up was 24 months. Main indications were traumatic scarring (22 eyes), corneal dystrophy (13 eyes), scarring after keratitis (10 eyes), graft failure (7 eyes), and chemical burn (5 eyes). There were 15 lamellar homologous not HLA-matched keratoplasties, 11 autologous penetrating rotating, 42 penetrating homologous not HLA-matched, and 3 penetrating homologous HLA matched. The most frequent complications were loosening or rupture of the suture in 38% and graft rejection in 20% of the homologous penetrating keratoplasties. 10 of 15 eyes after lamellar grafting showed a clear graft at the last control. 40 of 42 eyes after penetrating keratoplasty had also a clear graft, however second keratoplasties were necessary in 4 eyes. 21 of the 42 eyes after penetrating keratoplasty developed a visual acuity of 0.5 or better.
Conclusion: We recommend interrupted single sutures for keratoplasties in children and an earlier suture removal to avoid severe suture problems. Visual outcome depends on the primary diagnosis and on avoiding irreversible amblyopia. In cases of traumatic corneal and lens opacification an early rehabilitation of the optic system is important, therefore in patients under 7 years of age we prefer a posterior chamber lens implantation for a more effective amblyopia therapy.