Penetrating keratoplasty in the mentally retarded

Penetrating keratoplasty is infrequently performed in the mentally retarded due to the high risk of serious post-operative complications, in particular wound rupture and severe inflammation of the graft, Graft survival is hindered by the patient's tendency for eye rubbing and possibly self-indicted injury, Adequate nursing support is essential to ensure strict compliance with post-operative treatment, A retrospective study of corneal graft outcomes in mentally retarded patients was undertaken to assess graft survival, visual rehabilitation, post-operative complications and the influence on social behaviour, Six cases of penetrating keratoplasty performed in mentally retarded patients by one surgeon are presented, A continuous 10-0 nylon suture was employed in all cases, In 2 cases surgery was undertaken following perforation of the globe in patients with Down's syndrome, The grafts were retained in all cases and 2 patients achieved reasonably good acuity, although formal visual acuity assessment in these patients is limited. Penetrating keratoplasty in mentally retarded patients is a potentially hazardous procedure and patients require close supervision and good support care, This series demonstrates that relatively successful outcomes can be obtained in some mentally retarded patients.