{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T07:19:08Z","timestamp":1785568748958,"version":"3.56.0"},"reference-count":26,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2016,4,7]],"date-time":"2016-04-07T00:00:00Z","timestamp":1459987200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Acta Ophthalmologica"],"published-print":{"date-parts":[[2016,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Purpose<\/jats:title><jats:p>To report the indications and the outcomes of keratoplasties in children over four decades.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A retrospective cohort study of patients aged 16\u00a0years or younger who underwent keratoplasty in the Helsinki University Eye Hospital during 1968\u20132011. Diagnosis, preoperative status, age at the time of surgery, surgical technique, complications and follow\u2010up time were registered. Main outcome measures were visual acuity and graft survival as assessed by Kaplan\u2013Meier analysis. The independent role of risk factors on outcomes was evaluated by Cox multivariate regression analysis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Forty\u2010eight keratoplasties, 42 penetrating and six lamellar, were performed in 44 eyes of 39 children at the age of 4.5\u00a0months to 16\u00a0years (median, 12\u00a0years). Five patients had bilateral grafts, and five grafts were regrafts. The indication for keratoplasty was injury for 13 grafts, non\u2010traumatic acquired corneal opacities for 11, keratoconus for eight, corneal dystrophy for seven, congenital corneal opacities for six and aniridia for three grafts. The cumulative proportion of clear grafts was 46% at 5\u00a0years postoperatively, and the median follow\u2010up time of clear grafts was 5.1\u00a0years (range, 0.4\u201329\u00a0years) for 41 penetrating allografts (<jats:styled-content style=\"fixed-case\">PKP<\/jats:styled-content>). Simultaneous intraocular surgery at the time of grafting [hazard ratio (<jats:styled-content style=\"fixed-case\">HR<\/jats:styled-content>) 9.7], corneal vascularization (<jats:styled-content style=\"fixed-case\">HR<\/jats:styled-content> 8.1) and regrafting (<jats:styled-content style=\"fixed-case\">HR<\/jats:styled-content> 5.4) were the main independent risk factors for graft failure in this <jats:styled-content style=\"fixed-case\">PKP<\/jats:styled-content> cohort. The cumulative proportion of clear grafts was 84% at 5\u00a0years in the absence of any of these risk factors. <jats:styled-content style=\"fixed-case\">PKP<\/jats:styled-content> for keratoconus and corneal dystrophy yielded clear grafts in 83% of the eyes, and a visual acuity \u22650.3 (Snellen) in 75% of the eyes. Seventeen of the 20 graft failures were due to rejection.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Favourable graft survival was obtained in primary keratoplasties for non\u2010vascularized corneal opacities performed without any other simultaneous intraocular surgery. Visual outcome was favourable in keratoconus and corneal dystrophies and poor in most eyes with injury.<\/jats:p><\/jats:sec>","DOI":"10.1111\/aos.13040","type":"journal-article","created":{"date-parts":[[2016,4,10]],"date-time":"2016-04-10T17:41:58Z","timestamp":1460310118000},"page":"618-624","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":34,"title":["Indications and outcomes of keratoplasties in children during a 40\u2010year period"],"prefix":"10.1111","volume":"94","author":[{"given":"Anna","family":"Majander","sequence":"first","affiliation":[{"name":"Paediatric Service Department of Ophthalmology University of Helsinki and Helsinki University Hospital Helsinki Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tero T.","family":"Kivel\u00e4","sequence":"additional","affiliation":[{"name":"Ophthalmic Pathology Service Department of Ophthalmology University of Helsinki and Helsinki University 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