Authors: Mansoureh Bagheri, Kamiar Mireskandari, Nasrin Najm Tehrani, Asim Ali

Author Disclosure Block: M. Bagheri: None. K. Mireskandari: None. N. Najm Tehrani: None. A. Ali: None.

Abstract Body:

Purpose: To evaluate the outcomes of penetrating keratoplasty (PKP) and Ahmed glaucoma valve (AGV) implantation in pediatric patients with corneal opacity and glaucoma. Study Design: This was a retrospective case series. 

Methods: Clinical records of all children under 18 who underwent simultaneous or sequential PKP and AGV implantation from 2003 to 2017 were reviewed. Surgical success after AGV implantation was defined as a final IOP of 5 to 21 mmHg or a 30% reduction from baseline IOP after 3 months, and no secondary glaucoma surgery, loss of light perception, or devastating complications. Kaplan-Meier estimator was used for survival analysis. 

Results: Twenty-five eyes of 20 patients met the inclusion criteria. Peters anomaly, Sclerocornea, congenital hereditary endothelial dystrophy, congenital aniridia, Axenfeld-Rieger anomaly, penetrating globe injury, as well as corneal opacity associated with childhood glaucoma were the underlying eye conditions. The mean age at the time of first AGV implantation and PKP were 42.7 ± 48.9 and 33.3 ± 42.9 months, respectively. The cumulative probability of success after AGV implantation was 97%, 96 %, 90 %, 46 %, and 23 % at 1, 2, 5, 7, and 10.5 years of follow up, respectively. Eighteen eyes (72%), met the success criteria, of whom 6 eyes (24%) did not need anti-glaucoma medications at last follow up. Pre-operative intra-ocular pressure (IOP) decreased significantly from 29.0 ± 6.3 to 17.2 ± 7.3 (P=0.000). The cumulative probability of corneal graft survival was 82%, 67%, 43%, 32%, and 30% at 1, 2, 5, 7, and 12.5 years of follow up, respectively. Sixteen eyes had clear graft at last follow-up and 7 eyes needed repeated PKP. Microbial keratitis occurred in 3 eyes which lead to graft failure. 

Conclusions: PKP and AGV implantation can effectively reduce the IOP and restore corneal clarity with considerately significant success rate in pediatric patients with complex anterior segment eye diseases.