Y Z Wai, R Alias, N A Bahari, T Umapathy, S I Hosnaliza, J Rahmat
{"title":"A 15-year experience with keratoplasty in the management of paediatric corneal diseases: indications and clinical outcomes in Malaysia.","authors":"Y Z Wai, R Alias, N A Bahari, T Umapathy, S I Hosnaliza, J Rahmat","doi":"","DOIUrl":null,"url":null,"abstract":"<p><strong>Introduction: </strong>Corneal blindness is a leading yet preventable cause of childhood blindness worldwide. Despite the need for corneal transplantation in paediatric cases, comprehensive data on its aetiology, clinical outcomes, and graft survival in Malaysia remain scarce. This study reviews the indications and outcomes of paediatric keratoplasty at Hospital Kuala Lumpur over the past 15 years.</p><p><strong>Materials and methods: </strong>We conducted a retrospective evaluation of paediatric patients (less than 12-years-old) who underwent keratoplasty in Hospital Kuala Lumpur, from January 2008 to December 2022. We analysed demographic data, preoperative diagnoses, types of keratoplasty performed, and the 1-year graft survival rate.</p><p><strong>Results: </strong>100 eyes from 95 patients were included in the study, with a mean age of 4.39 ±3.32 years. The indications for keratoplasty included limbal dermoid (45%), anterior segment dysgenesis/Peter's anomaly (22%), infective keratitis (14%), congenital glaucoma (4%), and other pathologies (15%). 31/100 (31%) had corneal perforation. Of the patients, 56% underwent lamellar keratoplasty (LK), while 44% underwent penetrating keratoplasty (PK). Complications included wound dehiscence (4%) and graft melting (3%). 77% completed 1-year follow-up, and the overall 1-year graft survival rate was 54.5%. Limbal dermoid showed a better graft survival rate (72.2%) compared to other pathologies (39%), with a p-value of 0.004. LK has a higher 1-year graft survival rate of 66% compared to PK (36.7%) with a p-value of 0.003. Among the cases of perforated corneas, an overall 1-year graft survival rate of 25.8% (8/31) was observed, which was significantly lower compared to eyes without corneal perforation 73.9% (34/46) with a p-value of 0.008.</p><p><strong>Conclusions: </strong>Limbal dermoid was the most common indication for paediatric keratoplasty, and it exhibited a better graft survival rate compared to other pathologies. A one-year graft survival rate varies among different indications of keratoplasty. Perforated cornea has a lower graft survival rate compared to non-perforated corneal pathology.</p>","PeriodicalId":39388,"journal":{"name":"Medical Journal of Malaysia","volume":"80 2","pages":"141-146"},"PeriodicalIF":0.0000,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Medical Journal of Malaysia","FirstCategoryId":"1085","ListUrlMain":"","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"Medicine","Score":null,"Total":0}
引用次数: 0
Abstract
Introduction: Corneal blindness is a leading yet preventable cause of childhood blindness worldwide. Despite the need for corneal transplantation in paediatric cases, comprehensive data on its aetiology, clinical outcomes, and graft survival in Malaysia remain scarce. This study reviews the indications and outcomes of paediatric keratoplasty at Hospital Kuala Lumpur over the past 15 years.
Materials and methods: We conducted a retrospective evaluation of paediatric patients (less than 12-years-old) who underwent keratoplasty in Hospital Kuala Lumpur, from January 2008 to December 2022. We analysed demographic data, preoperative diagnoses, types of keratoplasty performed, and the 1-year graft survival rate.
Results: 100 eyes from 95 patients were included in the study, with a mean age of 4.39 ±3.32 years. The indications for keratoplasty included limbal dermoid (45%), anterior segment dysgenesis/Peter's anomaly (22%), infective keratitis (14%), congenital glaucoma (4%), and other pathologies (15%). 31/100 (31%) had corneal perforation. Of the patients, 56% underwent lamellar keratoplasty (LK), while 44% underwent penetrating keratoplasty (PK). Complications included wound dehiscence (4%) and graft melting (3%). 77% completed 1-year follow-up, and the overall 1-year graft survival rate was 54.5%. Limbal dermoid showed a better graft survival rate (72.2%) compared to other pathologies (39%), with a p-value of 0.004. LK has a higher 1-year graft survival rate of 66% compared to PK (36.7%) with a p-value of 0.003. Among the cases of perforated corneas, an overall 1-year graft survival rate of 25.8% (8/31) was observed, which was significantly lower compared to eyes without corneal perforation 73.9% (34/46) with a p-value of 0.008.
Conclusions: Limbal dermoid was the most common indication for paediatric keratoplasty, and it exhibited a better graft survival rate compared to other pathologies. A one-year graft survival rate varies among different indications of keratoplasty. Perforated cornea has a lower graft survival rate compared to non-perforated corneal pathology.
期刊介绍：
Published since 1890 this journal originated as the Journal of the Straits Medical Association. With the formation of the Malaysian Medical Association (MMA), the Journal became the official organ, supervised by an editorial board. Some of the early Hon. Editors were Mr. H.M. McGladdery (1960 - 1964), Dr. A.A. Sandosham (1965 - 1977), Prof. Paul C.Y. Chen (1977 - 1987). It is a scientific journal, published quarterly and can be found in medical libraries in many parts of the world. The Journal also enjoys the status of being listed in the Index Medicus, the internationally accepted reference index of medical journals. The editorial columns often reflect the Association''s views and attitudes towards medical problems in the country. The MJM aims to be a peer reviewed scientific journal of the highest quality. We want to ensure that whatever data is published is true and any opinion expressed important to medical science. We believe being Malaysian is our unique niche; our priority will be for scientific knowledge about diseases found in Malaysia and for the practice of medicine in Malaysia. The MJM will archive knowledge about the changing pattern of human diseases and our endeavours to overcome them. It will also document how medicine develops as a profession in the nation. We will communicate and co-operate with other scientific journals in Malaysia. We seek articles that are of educational value to doctors. We will consider all unsolicited articles submitted to the journal and will commission distinguished Malaysians to write relevant review articles. We want to help doctors make better decisions and be good at judging the value of scientific data. We want to help doctors write better, to be articulate and precise.
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