Secondary Logo

Institutional members access full text with Ovid®

Recent Surgical Trends in Pediatric Corneal Transplantation

A 13-Year Review

Zhu, Angela Y., MD; Prescott, Christina R., MD, PhD

doi: 10.1097/ICO.0000000000001900
Clinical Science

Purpose: Corneal transplantation is the standard of care for pediatric corneal opacities, but little consensus exists on optimal surgical management. Our goal was to evaluate cross-sectional data of donor and recipient characteristics collected from eye banks providing tissue for pediatric corneal transplant cases to assess surgical trends in pediatric keratoplasty over the past 13 years.

Methods: We performed a retrospective review of recipient data, collected from 4 major eye banks, for pediatric patients (<18 years) who underwent corneal transplantation between January 2005 and December 2017. We analyzed trends in surgical indications, types of keratoplasty, and donor/recipient characteristics.

Results: Our database included 2620 total pediatric cases. Penetrating keratoplasty (PKP) remains the most common surgery performed (79.8%), but more partial-thickness transplant cases [eg, endothelial keratoplasty (EK)] have been performed since 2008. The most commonly reported transplant indication was ectasias/thinnings (34.1%) overall and congenital opacities (17.0%) in children less than 5 years. Average donor age was significantly lower for the youngest recipient age group of less than 5 years (P < 0.001); endothelial cell count was also higher, and death-to-surgery time was lower for PKP and EK cases versus other keratoplasties.

Conclusions: Indications for transplant vary across age groups but are consistent with previous reports. Popularity of partial-thickness transplants has increased since 2008. Surgeons prefer younger donor tissue for younger patients and have higher thresholds for endothelial cell count for PKP and EK cases. Centralized tracking of pediatric keratoplasty cases is necessary for further investigation of long-term outcomes.

Department of Ophthalmology, Johns Hopkins Wilmer Eye Institute, Baltimore, MD.

Correspondence: Christina R. Prescott, MD, PhD, Wilmer Eye Institute, Johns Hopkins Medical Institutions, Woods Building 367, 600 North Wolfe St, Baltimore, MD 21287 (e-mail:

The authors have no funding or conflicts of interest to disclose.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (

Received November 11, 2018

Received in revised form January 03, 2019

Accepted January 04, 2019

Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.