Tomographic indices as possible risk factors for progression in pediatric keratoconus

Hamilton, Alexander; Wong, Scott; Carley, Fiona; Chaudhry, Nadia; Biswas, Susmito

doi:10.1016/j.jaapos.2016.08.006

Cited by 26 publications

(19 citation statements)

References 22 publications

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“…In fact, Lass et al [49] found that previous contact lens history, BCVA of 20/50 or worse and average keratometry of 55 D or greater at baseline were risk factors for penetrating keratoplasty. Hamilton et al [52] suggested that eyes with the thinnest corneal thickness <450 μm, higher average central keratometry above 50 D and maximum center posterior elevation above 50 μm at presentation seemed to be risk factors for faster rates of corneal thinning and can be used as tomographic indices for progression. L’eoni-Mespli’e et al [53] reported in a retrospective study that keratoconus was more severe in children at diagnosis compared to adults (27.8% at stage four vs. 7.8%, respectively), and after diagnosis the disease did not evolve more quickly in children.…”

Section: Rate Of Progressionmentioning

confidence: 99%

Pediatric keratoconus: a review of the literature

2017

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Purpose To describe the epidemiology and prevalence, rates of progression, difference between adult and pediatric populations, and therapeutic approaches to pediatric keratoconus from documented literature. Methods A literature search was done on PubMed using key words including pediatric keratoconus, children with keratoconus, adult keratoconus, penetrating keratoplasty, corneal cross-linking and intra-corneal ring segments. The literature was reviewed and reported to explore the key epidemiological differences between the pediatric and adult population with regards to presentation and treatment options. Results Pediatric keratoconus is more aggressive than adult keratoconus, which has been explained by structural differences in the cornea between both populations. High rates of progression were documented in pediatric populations. While corneal collagen cross-linking, intracorneal ring segments and penetrating keratoplasties have been used as therapies in the pediatric population, the literature overwhelmingly shows higher rates of failure and progression despite these measures as compared to adults. Conclusion Pediatric keratoconus is more aggressive than adult keratoconus, and current therapies used in adults may not be sufficient for the pediatric population.

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Section: Rate Of Progressionmentioning

confidence: 99%

Pediatric keratoconus: a review of the literature

2017

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“…A retrospective study found eye rubbing behavior to be present in 91.84% of patients diagnosed before age 15, which was significantly higher than 70.06% of those diagnosed after age 27 [20]. Another study found eye rubbing to be present in 79% of a pediatric population, with all patients showing clinical signs of allergic eye disease [5]. Although the exact mechanism by which keratoconus may develop remains to be elucidated, McMonnies proposed the following responses to occur due to eye rubbing: increase in corneal temperature, epithelial thinning, increased inflammatory mediators in the tear film, abnormal enzyme activity, intraocular pressure spikes, high hydrostatic tissue pressure, thixotropic decrease in ground substance viscosity, temporary displacement of ground substance from the corneal apex, curvature transfer to the cone apex, slippage between collagen fibrils at the cone apex, changes to keratocytes, and corneal scarring [21].…”

Section: Discussionmentioning

confidence: 99%

“…Keratoconus often presents during the second decade of life. It can be isolated or associated with other ocular and systemic disorders including vernal keratoconjunctivitis, atopy, Down syndrome, intellectual disability, and Leber congenital amaurosis [ 3 – 5 ]. However, it is considered a rare condition in young children [ 4 , 6 , 7 ].…”

Section: Introductionmentioning

confidence: 99%

A Case of Early Keratoconus Associated with Eye Rubbing in a Young Child

Dimacali

Balidis²,

Adamopoulou³

et al. 2020

Ophthalmol Ther

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Introduction: Keratoconus usually presents during puberty and is considered rare in young children. Methods: Case report with clinical findings and computerized corneal tomography. Results: We report the case of an 8-year-old girl with early bilateral keratoconus who presented with allergic conjunctivitis and persistent eye rubbing. Although our patient did not exhibit steep keratometry, early cones and inferotemporal thinnest corneal thicknesses were detected in both eyes using Scheimpflug imaging (Oculus GmbH Pentacam, Wetzlar, Germany). Belin/Ambró sio total D values were 1.85 on the right and 2.11 on the left. Improvement in best-corrected visual acuity was noted after treatment of allergic eye disease, and corneal tomographic findings remained stable 4 months after initial consult. Conclusion: This is a case of early diagnosed keratoconus in a young patient. Diagnosis of this condition in young children is challenging, as these patients are less likely to report visual complaints, and clinical examination is usually unremarkable. Keratoconus screening should be considered in children with atopy and eye rubbing behavior regardless of age, even in those with no other associated pathology and with negative family history.

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“… 1 The progression of keratoconus occurs more intensely in the second and third decades of life and is more aggressive at puberty. 2 , 3 Its etiology is multifactorial, involving genetic and environmental factors. 4 …”

Section: Introductionmentioning

confidence: 99%

“…Keratoconus is a corneal ectasia which leads to progressive stromal thinning and protrusion, resulting in irregular astigmatism, visual impairment, and decreased quality of life, with a prevalence of approximately 1:2000, with varying susceptibilities in different ethnic groups 1 . The progression of keratoconus occurs more intensely in the second and third decades of life and is more aggressive at puberty 2 , 3 . Its etiology is multifactorial, involving genetic and environmental factors 4 …”

Section: Introductionmentioning

confidence: 99%

Are iris mammillations correlated with keratoconus?

Antunes-Foschini

Costa

Sousa

et al. 2019

American Journal of Ophthalmology Case Reports

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PurposeTo describe the presence of iris mammillations (IM) in keratoconus.DesignRetrospective case series and literature review.ObservationsThis is a retrospective case series of eight patients presenting with keratoconus and IM, who were examined between January 2016 and December 2017 in the ophthalmology outpatient clinic. They had a median age of 14 (11–30), and all had bilateral keratoconus and diffusely distributed IM. The IM had similar presentations and similar iris colors. None had relevant medical or family diseases associated with IM. Three eyes previously had penetrating keratoplasty. Four (31%) out of 13 eyes had mean keratometry (Km) > 55D, and 4 (31%) had the thinnest pachymetry between 300 and 400μm.Conclusions and importanceTo the best of our knowledge, this is the first time that IM was observed in association with keratoconus patients. The possibility that IM is an early finding in otherwise healthy patients may help to predict the future diagnosis of keratoconus. Future studies are needed to show the frequency and possible association between IM and a keratoconus prognosis. This may also demonstrate that there is a subgroup of patients with a distinct etiology of keratoconus.

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Tomographic indices as possible risk factors for progression in pediatric keratoconus

Cited by 26 publications

References 22 publications

Pediatric keratoconus: a review of the literature

Pediatric keratoconus: a review of the literature

A Case of Early Keratoconus Associated with Eye Rubbing in a Young Child

Are iris mammillations correlated with keratoconus?

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