Objective

To report outcomes of tacrolimus immunosuppression after penetrating keratoplasty (PK) in very young children.

Methods

Retrospective, consecutive, cohort study of children undergoing PK at a tertiary children’s hospital between 2005 and 2016. Oral tacrolimus immunosuppression was given for 2 years, followed by topical tacrolimus.

Results

Fourteen children (20 eyes) had 24 PKs; nineteen eyes had primary PKs, five eyes had repeat PKs. Mean age at primary graft was 95 days (3.1 months) for anterior segment dysgenesis (ASD), 430 days (14.3 months) for non-ASD children. Eleven children (15 eyes) had ASD. Three children (five eyes) had non-ASD: two children (three eyes) had glaucoma-related corneal opacity and one child (two eyes) had congenital hereditary endothelial dystrophy (CHED).

One-year rejection-free survival rates following primary PK was 80% for ASD (n = 15) and 100% for non-ASD (n = 4). At final review, 5/15 of primary grafts for ASD were clear. 10/15 failed after a mean of 19 months, specifically attributable to infection (n = 2), rejection (n = 2) and glaucoma (n = 2). 4/4 primary non-ASD grafts are clear at final review (mean follow-up = 77 months). All repeat grafts (n = 5), failed after a mean of 38.25 months. Considering all grafts, 15/24 (62.5%) failed: 5/15 due to infection, 2/15 due to rejection, 8/15 due to glaucoma, phthisis, perforation or vascularised with no rejection. At last review (mean = 58.1 months, range 28–84), overall cohort survival is 37.5%. Final visual acuities range between 0.86 and 2.4 LogMAR.

Conclusion

We compare our results to published literature: 1-year graft survival was higher than previously reported, with lower failure due to rejection. Overall infection rates did not increase, however, proportionally, severe infections were higher. Overall graft survival is at least comparable to reported literature.

中文翻译：

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他克莫司全身免疫抑制治疗婴幼儿穿透性角膜移植术后的结果

 客观的

报告幼儿穿透性角膜移植术 (PK) 后他克莫司免疫抑制的结果。

 方法

回顾性、连续性、队列研究，对2005年至2016年在三级儿童医院接受PK的儿童进行。口服他克莫司免疫抑制剂2年，随后外用他克莫司。

 结果

14名儿童（20只眼睛）进行了24次PK；十九只眼睛进行初级 PK，五只眼睛进行重复 PK。前段发育不全 (ASD) 儿童初次移植的平均年龄为 95 天（3.1 个月），非 ASD 儿童为 430 天（14.3 个月）。 11 名儿童（15 只眼睛）患有 ASD。三名儿童（五只眼睛）患有非 ASD：两名儿童（三只眼睛）患有青光眼相关的角膜混浊，一名儿童（两只眼睛）患有先天性遗传性内皮营养不良 (CHED)。

ASD 初次 PK 后的一年无排斥生存率为 80%（ n = 15)，非自闭症谱系障碍 (ASD) 为 100%（ n = 4）。在最终审查中，5/15 的 ASD 初次移植物是干净的。 10/15 平均 19 个月后失败，具体归因于感染（ n = 2), 拒绝 ( n = 2) 和青光眼 ( n = 2).最终审查时，4/4 的原发性非 ASD 移植物是明确的（平均随访 = 77 个月）。所有重复移植物（ n = 5)，平均 38.25 个月后失败。考虑到所有移植物，15/24 (62.5%) 失败：5/15 由于感染，2/15 由于排斥，8/15 由于青光眼、肺痨、穿孔或血管化但无排斥。在上次审查时（平均 = 58.1 个月，范围 28-84），队列总体生存率为 37.5%。最终视力范围在 0.86 至 2.4 LogMAR 之间。

 结论

我们将我们的结果与已发表的文献进行比较：移植物的 1 年存活率高于之前报道的，并且因排斥反应导致的失败率较低。总体感染率没有增加，但严重感染率却按比例增加。总体移植物存活至少与报道的文献相当。