Xie Li-xin, Ma Lin, Dong Xiao-guang, Shi Wei-yun
Shandong Eye Institute, Qingdao Eye Hospital, Qingdao 266071, China.
Zhonghua Yan Ke Za Zhi. 2007 Nov;43(11):1005-9.
To evaluate indications, surgical details, factors affecting graft survival and determinants of visual acuity after penetrating keratoplasty (PKP) in children.
This was a retrospective analysis of 266 grafts of PKP performed in 257 eyes of 236 children, aged younger than 14 years between June 1994 and June 2004 in Shandong Eye Institute and Qingdao Eye Hospital. The patient characteristics, indications, and outcome with follow up 6 months to 9 years and 5 months, mean (21 +/- 13) months were evaluated.
On the basis of the corneal pathology, the indications of pediatric PKP were divided into three categories: related to congenital, hereditary and growth (99 eyes, 38.5%), related to trauma (82 eyes, 31.9%) and related to keratitis (76 eyes, 29.6%). At the last follow-up, the best corrected visual acuity of 146 eyes were better than 0.05, 37.7% (55/146) of these eyes were related to keratitis, and 55.5% (81/146) aged more than 9 years; 190 (190/266, 71.4%) of total grafts remained clear, in which, 52 (52/73, 71.2%) grafts were related to additional surgical procedures remained clear, 24 (24/48, 50.0%) were bilateral grafts and 8 (8/21, 38.1%) were repeat grafts. There was no significant difference between only PKP and PKP additional surgical procedures (chi(2) = 0.002, P = 0.965), and there was significant difference between the unilateral and bilateral grafts (chi(2) = 13.178, P = 0.000), between once and repeat PKP (chi(2) = 12.413, P = 0.000).
The indications related to congenital, hereditary and growth are the main cause of pediatric PKP. The outcome is concerned with indications, ages onset, additional surgical procedures, bilateral grafts, and so on. Pediatric PKP is of benefit to children avoiding blindness caused by corneal opacity, especially combined with pre- and post-operative care.
评估儿童穿透性角膜移植术（PKP）的适应证、手术细节、影响植片存活的因素以及视力的决定因素。
对1994年6月至2004年6月在山东眼科研究所和青岛眼科医院为236例14岁以下儿童的257只眼施行的266例PKP植片进行回顾性分析。评估患者的特征、适应证以及随访6个月至9年零5个月（平均[21±13]个月）的结果。
根据角膜病理，儿童PKP的适应证分为三类：与先天性、遗传性和发育相关（99只眼，38.5%）、与外伤相关（82只眼，31.9%）和与角膜炎相关（76只眼，29.6%）。在最后一次随访时，146只眼的最佳矫正视力优于0.05，其中37.7%（55/146）的眼与角膜炎相关，55.5%（81/146）的眼年龄大于9岁；266例植片中190例（190/266，71.4%）植片保持透明，其中，与附加手术相关的52例（52/73，71.2%）植片保持透明，24例（24/48，50.0%）为双眼植片，8例（8/21，38.1%）为再次移植。单纯PKP与PKP联合附加手术之间无显著差异（χ² = 0.002，P = 0.965），单眼与双眼植片之间有显著差异（χ² = 13.178，P = 0.000），初次与再次PKP之间有显著差异（χ² = 12.413，P = 0.000）。
与先天性、遗传性和发育相关的适应证是儿童PKP的主要原因。结果与适应证、发病年龄、附加手术、双眼植片等有关。儿童PKP有利于避免儿童因角膜混浊导致失明，尤其是结合术前和术后护理。
