Corneal Transplant Survival Rate Nearly 30% For Children With Glaucoma

Pediatric patients with glaucoma who undergo corneal transplantation have a high incidence of graft failure.

Corneal transplant survival rate is approximately 29% at 24 months in pediatric patients who have glaucoma, according to a case series published in the Journal of Glaucoma. Researchers evaluated the corneal grafts of children who underwent with Descemet stripping automated endothelial keratoplasty (DSAEK) or penetrating keratoplasty (PK) to manage corneal decompensation.

Researchers reviewed surgical outcomes of different types of keratoplasty in eyes of children with comorbid glaucoma. They considered medical records from 17 eyes of 15 patients who had a diagnosis of childhood glaucoma and received a corneal transplant between January 2010 and July 2020. The team collected patients’ demographic data, intraocular pressures (IOP), previous ocular surgery history (including corneal transplant surgery), comorbidities, and follow-up outcomes.

The study’s primary efficacy endpoint was graft survival (in months) until failure, where failure was considered the irreversible loss of corneal transparency. Need for an increase in topical hypotensive therapy and need for additional surgery were secondary efficacy end points.

Of the included eyes, 11 had primary congenital glaucoma (PCG) and 6 had other types of childhood glaucoma. Mean patient age at the time of corneal transplant surgery was 23.76 years. The number of topical medications at the time of corneal transplant was 1.35±1.27, IOP was 15.00±8.34 mm Hg and patients received up to 7 glaucoma surgeries. Researchers performed DSAEK in 13 eyes (76%) and PK in 4 eyes (24%).

Although childhood glaucoma is a rare disease, endothelial dysfunction in these patients
commonly presents as a challenge.

Seven eyes (41%) required increased topical treatment and 2 eyes (12%) required glaucoma surgery after the initial surgery. The mean time of survival, where 12 eyes (71%) developed corneal graft failure at 24 months, was 13.88±8.25 months.

The researchers note that, though uncommon, childhood glaucoma is estimated to contribute to 4% to 18% of childhood blindness, and that it has a significant impact on normal development. The study shows no difference between the corneal transplant survival rate in eyes that were treated with DSAEK compared with eyes treated with PK.

“Although childhood glaucoma is a rare disease, endothelial dysfunction in these
patients commonly presents as a challenge,” the researchers explain.

In a case series, researchers evaluated the outcomes of corneal transplants in participants with childhood glaucoma.


Vidal-Villegas B, Burgos-Blasco B, Ariño-Gutierrez M, et al. Outcomes of corneal transplant in childhood glaucoma. J Glaucoma. Published online May 16, 2023. doi:10.1097/IJG.0000000000002234