Corneal transplantation in kids with glaucoma tied to increased risk of complications and graft failure

Childhood glaucoma, a rare but severe eye condition, has long been associated with complex challenges in treatment and management. New study brought out the difficulties faced by these young patients, particularly concerning corneal transplants. The findings published in the Journal of Glaucoma reveals that survival rates for corneal transplants in childhood glaucoma patients stand at just 29% at the two-year mark.

The study's objective was clear: to investigate the surgical outcomes of different types of keratoplasty in eyes affected by childhood glaucoma. A retrospective review was conducted, analyzing the medical records of 17 eyes belonging to 15 patients diagnosed with childhood glaucoma. These patients had undergone corneal transplantation between January 2010 and July 2020.

The data collected included patient demographics, intraocular pressure, previous ocular surgeries, comorbidities, details of the corneal transplant surgery, and post-operative outcomes. The primary focus was on graft survival, measured in months until irreversible loss of corneal transparency occurred, marking graft failure. Secondary points of interest included the need for increased topical hypotensive therapy and the necessity for additional surgeries.

The results revealed the challenges faced by these young patients. The surgeries were performed at a mean age of approximately 24 years. At the time of transplantation, the patients were already using an average of 1.35 topical medications, with an average intraocular pressure of 15 mm Hg. Alarmingly, some patients had already undergone up to seven glaucoma surgeries before the transplant.

Two types of keratoplasty were employed, with Descemet stripping automated endothelial keratoplasty being the most common (76%), and penetrating keratoplasty (24%).

The post-operative period presented additional hurdles, with 41% of eyes requiring an increase in topical treatment and 12% necessitating further glaucoma surgery. The most disheartening revelation was that a whopping 71% of eyes experienced graft failure within 24 months, with an average survival time of just 13.88 months.

This study underscores the difficulties faced by these patients, with corneal transplant survival rates as low as 29% at the two-year mark. It highlights the urgent need for more effective treatments and interventions to improve the outlook for these young individuals affected by this debilitating condition.

Reference:

Vidal-Villegas, B., Burgos-Blasco, B., Ariño-Gutierrez, M., Cuiña Sardiña, R., Mendez-Hernandez, C. D., Torres-Gonzalez, J. I., Mendez-Fernandez, R., Díaz-Valle, D., & García-Feijóo, J. (2023). Outcomes of Corneal Transplant in Childhood Glaucoma. In Journal of Glaucoma (Vol. 32, Issue 8, pp. 701–707). Ovid Technologies (Wolters Kluwer Health). https://doi.org/10.1097/ijg.0000000000002234