To report outcomes of pediatric penetratingkeratoplasty (PK) performed in a tertiary referral medical center between 2001 and 2012.

In this retrospective interventional case series, medical records of all pediatric patients (age ≤ 12years) who underwent primary PK were compiled. Age at the time of surgery, indications for keratoplasty, postoperative UCVA and best spectacle-corrected visual acuity (BSCVA), postoperative refractive error , graft rejection episodes, graft clarity at the final follow-up exam, cause of graft failure and secondary intervention were reported. Cumulative graft survival was calculated using Kaplan-Meier method.

Fifty-four eyes of 45 children (27 male) were enrolled. Unilateral PK wasperformed in 36 cases and 9 patients underwent sequential bilateral PK. The surgical indications were aphakic bullous keratopathy(n=2;3.7%), anterior segment dysgenesis(n=8;14.8%), congenital hereditary endothelial dystrophy (CHED, n= 17; 31.5%),keratoconus(n=9; 16.7 %),corneal perforation (n=8; 14.8 %) , corneal scars(n=4; 7.4%) and trauma (n=6; 11.1 %). Cumulative graft survivalfor 6 months,1,2 and 3 years were 74%,68%,65% and 62%, respectively. The graft survival was highest in old corneal scar and keratoconus (100% clear at month 60.2) followed by CHED(82.3% at month 61.06).

Pediatric PK yielded the best results when the indications were KCN and old corneal scar followed by CHED.