Characteristics of pediatric keratoconus and the role of corneal topography in early diagnosis: A prospective study

Abstract

Purpose: The purpose of this study is to describe the clinical and topographical features of keratoconus in children and to emphasize the role of corneal topography in early diagnosis of keratoconus in eyes with astigmatism. Materials and Methods: It was a prospective study done to screen children below 18 years with astigmatism of 1.50 Diopter or greater for presence of keratoconus. Ophthalmic evaluation included retinoscopy, cycloplegic refraction, and detailed slit lamp examination for clinical diagnosis of keratoconus. All eyes underwent corneal topography and tomography. Eyes were followed up for progression with both refraction and corneal topographic imaging. Progressive cases later underwent Accelerated Collagen Crosslinking (ACXL). Results: 700 eyes of 350 patients with astigmatism were screened for keratoconus. 44 eyes of 28 patients were diagnosed with keratoconus. Mean age of the diagnosed children was 11.7 years (6–18 years), 18 boys and 10 girls. Overall, most common clinical association was allergic conjunctivitis. Twenty-five eyes (57%) had clinical evidence of keratoconus while other 19 eyes (43%) required corneal topography to establish the diagnosis. Based on the Amsler-Muckenheim tomographical classification, 22 of 44 eyes (50%) were grouped in prestage level followed by 13 eyes (29.5%) in Stage 1, 5 eyes (11.4%) in Stage 2, and 4 eyes (9.1%) in Stage 3. Thirty-five eyes of 21 patients showed progression and underwent ACXL. Conclusion: Early detection of keratoconus in children with astigmatism is of utmost importance to avoid visual impairment and surgical intervention. Even in the absence of clinical signs, corneal topography and tomography should be performed as a screening tool to rule out keratoconus in these children.