Outcomes of Corneal Transplant in Childhood Glaucoma

Beatriz Vidal-Villegas; Barbara Burgos-Blasco; Mayte Ariño-Gutierrez; Ricardo Cuiña Sardiña; Carmen Dora Mendez-Hernandez; Juan Ignacio Torres-Gonzalez; Rosalía Mendez-Fernandez; David Díaz-Valle; Julián García-Feijóo

doi:10.1097/IJG.0000000000002234

Outcomes of Corneal Transplant in Childhood Glaucoma

J Glaucoma. 2023 Aug 1;32(8):701-707. doi: 10.1097/IJG.0000000000002234. Epub 2023 May 16.

Authors

Affiliations

¹ Department of Ophthalmology, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria (IdISSC).
² Tissue Bank, Hospital Clínico San Carlos.
³ Transplant Coordination, Hospital Clínico San Carlos.
⁴ Departamento de Inmunología, Oftalmología y ORL, Facultad de Medicina, Universidad Complutense de Madrid; Madrid, Spain.

PMID: 37171990
DOI: 10.1097/IJG.0000000000002234

Abstract

Prcis: Childhood glaucoma produces alterations in the postnatal development and function of various ocular structures, including the cornea. Childhood glaucoma patients present lower corneal transplant survival rates. Our series shows outcomes of corneal transplant in childhood glaucoma with survival rates of 29% at 2 years.

Objective: To investigate the surgical outcome of different types of keratoplasty in eyes with childhood glaucoma.

Patients and methods: A retrospective review was made of the medical records from 17 eyes of 15 patients who were diagnosed with childhood glaucoma and received a corneal transplantation between January 2010 and July 2020. Patient demographics, intraocular pressure, previous ocular surgery, comorbidities, corneal transplant surgery, and follow-up outcome were collected. The primary efficacy endpoint was graft survival (in months) until failure, the latter being considered as irreversible loss of corneal transparency. Secondary efficacy points were the need for an increase in topical hypotensive therapy and the need for additional surgery.

Results: Seventeen eyes of 15 patients were included, 11 eyes (10 patients) with primary congenital glaucoma and 6 with other types of childhood glaucoma. Corneal transplantation was performed at the mean age of 23.76 ± 14.86 years. At the time of the transplantation, the number of topical medications was 1.35 ± 1.27, intraocular pressure was 15.00 ± 8.34 mm Hg, and patients had received up to 7 glaucoma surgeries. Descemet stripping automated endothelial keratoplasty was performed in 13 eyes (76%) and penetrating keratoplasty in 4 (24%). After surgery, 7 (41%) eyes required increased topical treatment and 2 (12%) glaucoma surgery. Twelve eyes (71%) developed graft failure at 24 months, the mean time of survival being 13.88 ± 8.25 months.

Conclusions: Management of corneal decompensation in childhood glaucoma poses a challenge. In this series of childhood glaucoma with corneal transplantations, the survival rate was 29% at 24 months.