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Pediatric Keratoconus: Topographic, Biomechanical and Aberrometric Characteristics
Yogita Gupta1, Namrata Sharma1, Prafulla K Maharana1
1Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, Delhi, India.
Insights
Pediatric keratoconus (KC) often presents with vernal keratoconjunctivitis (VKC), leading to more severe disease. Corneal biomechanical properties correlate with KC stage in children, highlighting the importance of early detection and management.
Area of Science:
- Ophthalmology
- Corneal Diseases
- Pediatric Eye Care
Background:
- Pediatric keratoconus (KC) is a progressive corneal ectasia affecting young individuals.
- Understanding its characteristics is crucial for timely diagnosis and management.
- Associated ocular conditions can influence disease severity and progression.
Purpose of the Study:
- To comprehensively evaluate the demographic, clinical, topographic, biomechanical, and aberrometric features of pediatric keratoconus.
- To identify associations and their impact on disease presentation and severity.
- To explore the relationship between corneal biomechanics and KC stage in pediatric patients.
Main Methods:
- A cross-sectional study involving pediatric KC patients (<18 years) at a tertiary hospital.
- Data collection included demographic profiles, clinical features, visual acuity, corneal topography, aberrometry, biomechanical analysis, and confocal microscopy.
- 116 eyes from 62 consecutive patients were analyzed.
Main Results:
- The cohort (mean age 14.7 years) was predominantly male (88%) with bilateral disease (92%).
- Progressive KC was observed in 46% of eyes, and acute hydrops in 8%.
- Vernal keratoconjunctivitis (VKC) was a significant ocular association (66.3%), with VKC eyes showing more severe KC (Stage IV in 46%). Refractive error and corneal aberrometry were notable.
- Corneal hysteresis and resistance factor correlated with KC stage (r=-0.26, P=.007).
Conclusions:
- Pediatric KC is frequently associated with VKC, which correlates with increased disease severity.
- A significant proportion of pediatric KC cases exhibit progressive disease.
- Corneal biomechanical parameters demonstrate a significant correlation with the stage of keratoconus in this pediatric population.
Purpose:
This study sought to evaluate the demographic profile, clinical features, topographic features, and biomechanical and aberrometric characteristics in pediatric keratoconus (KC).
Design:
Cross-sectional study.
Methods:
Pediatric KC cases <18 years of age were evaluated at a tertiary hospital. Main outcome measurements were demographic profile, clinical features, visual acuity, corneal topography, aberrometry, and biomechanical and confocal microscopy findings.
Results:
A total of 116 eyes of 62 consecutive patients were recruited with a mean ± age of 14.7 ± 2.77 years (range: 8-18 years); 46 of 62 (88%) were males; 57 of 62 cases (92%) had bilateral disease; 53 of 116 eyes (46%) had progressive KC; and 9 of 116 eyes (8%) had acute hydrops. Systemic associations were found in 6 of 62 patients (9.7%) and ocular associations in 77 of 116 eyes (66.3%); 68 of 116 eyes (58.6%) had associated vernal keratoconjunctivitis (VKC). Among eyes with VKC, 29 of 68 eyes (46%) were in stage IV KC, versus 25% of eyes with no VKC (P = .004). The mean ± SD refractive spherical equivalent was -4.72 ± 3.32 diopters (D), and refractive astigmatism was 3.69 ± 3.09 D. The mean values of maximum keratometry, thinnest pachymetry, and corneal higher-order aberrations were 60.89 ± 10.9 D, 396.05 ± 95.03 μm, and 1.18 ± 1.2 μm, respectively. Values of corneal hysteresis and corneal resistance factor correlated with the stage of KC (r = -0.26; P = .007).
Conclusions:
Pediatric KC was commonly associated with VKC in this cohort. Eyes with VKC had more severe KC than those without VKC. Nearly half of the patients presented with progressive disease. Corneal biomechanical changes correlated well with stage of KC in this pediatric age group.
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