Abstract
Introduction The Global Delphi Panel of Keratoconus (KC) and Ectatic Diseases formulated management guidelines for KC in 2015. The aim of this study was to evaluate management outcomes in pediatric KC. Materials and Methods Prospective, interventional study was conducted at a tertiary care hospital including KC patients aged <18 years. Based on disease severity and progression of disease, patients were prescribed either glasses or contact lenses (CLs) or underwent corneal collagen crosslinking (CXL), deep anterior lamellar keratoplasty (DALK), or penetrating keratoplasty (PK). Main Outcome Measures. Best corrected visual acuity (BCVA), manifest cylinder, maximum keratometry, thinnest corneal thickness, total higher order aberrations, and corneal hysteresis at baseline and 12 and 24 months. Results 116 eyes of 62 patients with a mean age of 14.76 ± 2.77 years were included. 32.8% of the eyes (n = 38) achieved satisfactory BCVA with glasses/CLs only. Corneal collagen crosslinking (CXL) was performed in 43.1% of the eyes (n = 50) with progressive KC and halting of progression was noted in 83.3% (n = 35) of the eyes at 2 years. 7.7% of the eyes (n = 9) were managed for acute hydrops. DALK and PK were successfully performed in 9.5% (n = 11) and 6.9% (n = 8) of the eyes with BCVA of 0.14 ± 0.09 and 0.08 ± 0.12 at 2 years, respectively. Conclusions Pediatric KC cases with progression show good visual and aberrometric outcomes and halting of progression after CXL. DALK and PK have good outcomes. The global consensus guidelines showed good clinical utility in pediatric patients. Presence of VKC did not have an impact on the outcomes of CXL in pediatric patients.
Highlights
Keratoconus (KC) is an ectatic condition of the cornea, associated with progressive corneal thinning
Agreements reached upon nonsurgical management of KC were a verbal guidance to patients to avoid rubbing, use of topical antiallergic medications, use of preservative-free lubricants, and use of glasses or scleral, hybrid, and gas-permeable contact lenses (CLs) for visual rehabilitation [7]. e panel consensus for surgical management suggested corneal collagen crosslinking (CXL) in patients with perceived risk of progression and in young patients (∼15 years of age) with progressive KC even with satisfactory vision with glasses, followed by glasses/CLs [7]
At 24 months, logMAR Best corrected visual acuity (BCVA) improved significantly from 1.84 ± 0.27 to 1.346 ± 0.52 (p < 0.001). These patients were subsequently registered for corneal transplantation (DALK/PKP). e outcomes of these surgeries in healed hydrops cases were not reported in the current study
Summary
Keratoconus (KC) is an ectatic condition of the cornea, associated with progressive corneal thinning. Last two decades have seen an emergence of new knowledge leading to a better diagnosis and management of KC. E panel consensus for surgical management suggested corneal collagen crosslinking (CXL) in patients with perceived risk of progression (i.e., clinical progression has not been confirmed) and in young patients (∼15 years of age) with progressive KC even with satisfactory vision with glasses, followed by glasses/CLs [7]. For KC eyes without the evidence of progression, there was no consensus on whether there is an age below which CXL may be performed or on whether any uncorrected visual acuity better than which CXL may be Journal of Ophthalmology restricted [7]. Intracorneal ring segments (ICRS) were suggested as a treatment option in stable KC with adequate corneal thickness and minimal scarring but unsatisfactory vision with glasses/CLs [7]
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