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Pediatric Keratoplasty in India: Indications and Outcomes

Sharma, Namrata MD*; Prakash, Gaurav MD*; Titiyal, Jeewan S MD*; Tandon, Radhika MD*; Vajpayee, Rasik B MS, FRCSEd, FRANZCO

doi: 10.1097/ICO.0b013e318074ce2e
Clinical Science

Purpose: To analyze the indications and outcomes of pediatric corneal transplantation surgery in a tertiary eye care center in the developing world.

Methods: In this longitudinal, retrospective study involving continuous cases, the records of 168 eyes of 154 children undergoing keratoplasty at a tertiary care center's specialized keratoplasty clinic during a 7-year period (1998-2004) were reviewed. The demography, etiology of opacification, visual acuity, and other findings were recorded. Intraoperative and postoperative details were reviewed. Major postoperative outcomes analyzed were visual acuity, graft survival, causes of graft failure, and follow-up duration.

Results: Infectious keratitis (43%) was the most common indication for keratoplasty, followed by congenital glaucoma (16.6%) and corneal trauma (11.2%). Overall 77% graft survival was seen at 36 months, and better graft outcome was associated with younger age and longer regular follow-up. Postoperatively, a best-corrected visual acuity (BCVA) > 20/200 could be achieved in only 30.1% of eyes at the last follow-up. Graft failure was seen in 18.4% of eyes, with graft infection being the most frequent cause (50%). Moreover, graft infection was the most common cause of graft failure in all age groups.

Conclusions: In the developing world, infectious keratitis is the most common indication for pediatric keratoplasty and the most frequent cause of its failure.

From the *Cornea and Refractive Surgery Services, Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India; and the †Centre for Eye Research Australia, University of Melbourne, East Melbourne, Victoria, Australia.

Received for publication January 20, 2007; revision received April 6, 2007; accepted April 7, 2007.

The authors state that they have no proprietary interest in the products in this article.

Reprints: Rasik B. Vajpayee, Head, Corneal & Cataract Surgery, Centre for Eye Research Australia, University of Melbourne, 32, Gisborne Street, East Melbourne, Victoria 3002, Australia (e-mail:

© 2007 Lippincott Williams & Wilkins, Inc.