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Published on: November 12, 2015
Natural history and predictors for progression in pediatric keratoconus
Rosalia Antunes-Foschini1, Henrique Doná2, Pedro Henrique Sant'Anna de Mello2
1Department of Ophthalmology, Otorhinolaryngology, and Head and Neck Surgery, Ribeirão Preto Medical School, University of São Paulo, Av. Bandeirantes, 3900, Ribeirão Preto, SP, CEP 14049-900, Brazil. antunesfoschini@gmail.com.
Insights
In pediatric keratoconus patients, steeper corneas (Kmax ≥ 55 D) predict faster progression. Allergy also increases progression risk in the right eye.
Area of Science:
- Ophthalmology
- Corneal Diseases
- Pediatric Eye Care
Background:
- Keratoconus progression in children requires understanding of predictive factors.
- Early identification of risk factors can guide management strategies.
Purpose of the Study:
- To identify demographic and clinical predictors of keratoconus progression in pediatric patients.
- To analyze factors influencing the time to keratoconus progression.
Main Methods:
- Retrospective cohort study of 168 pediatric patients (9-18 years) with 305 eyes and ≥36-month follow-up.
- Kaplan-Meier survival analysis used to determine time to event (1.5 D increase in maximum keratometry [Kmax]).
- Predictors evaluated included age, sex, family history, allergy, and baseline tomographic parameters (mean keratometry [Km], Kmax, thinnest pachymetry [TP]).
Main Results:
- Higher baseline maximum keratometry (Kmax ≥ 55 D) was associated with significantly shorter time to progression in both better (BE) and worse eyes (WE).
- Allergy was a significant predictor of faster keratoconus progression in the right eye (RE).
- No significant differences in progression were observed between right/left eyes (RE/LE) or better/worse eyes (BE/WE) overall.
Conclusions:
- Steeper baseline corneal curvature (Kmax ≥ 55 D) is a key predictor of accelerated keratoconus progression in pediatric patients.
- Allergic conditions may also contribute to faster disease progression, particularly in the right eye.
- These findings highlight the importance of baseline corneal topography and allergy assessment in managing pediatric keratoconus.
Abstract:
We studied the demographic and clinical predictors associated with keratoconus progression in a pediatric population. Retrospective cohort study. We evaluated 305 eyes without previous surgeries from 168 patients, 9 to < 18 years old, and with a minimum 36-month follow-up in a hospital corneal ambulatory. We used Kaplan-Meyer survival curves; the dependent variable (main outcome measure) was the interval time (months) until the event, defined as an increase of 1.5 D in the maximum keratometry (Kmax), obtained with Pentacam. We evaluated the predictors: age (< or ≥ 14 years), sex, keratoconus familial history, allergy medical history, and the baseline tomographic parameters: mean keratometry (Km), Kmax (< or ≥ 55 D); and thinnest pachymetry (TP). We used log-rank tests and compared median survival times for right (RE)/left eyes (LE) and better (BE)/worse eyes (WE). A p value < 0.05 was considered significant. The patients' mean ± SD age was 15.1 ± 2.3 years old; 67% were boys, 30% were < 14 years, 15% had keratoconus familial history, and 70% were allergic. The general Kaplan-Meyer curves showed no differences between RE/LE or BE/WE. RE with allergy and LE with Kmax ≥ 55 D had smaller survival times ((95%CI 9.67-32.1), p 0.031 and (95%CI 10.1-44.1), p 0.042, respectively). For BE and WE, Kmax ≥ 55 D had smaller survival times ((95% CI 6.42- ), p 0.031 and (95%CI 8.75-31.8), p 0.043, respectively). Keratoconus progression was similar between RE/LE and BE/WE. Steepest corneas are predictors of faster progression. Allergy is also a predictor of keratoconus progression in RE.
