Study Explores Management Options for Children With Clinically Suspected Keratoconus

Approximately one half of pediatric patients suspected of having keratoconus eventually progress to needing penetrating keratoplasty (PKP) or corneal cross-linking (CXL). New data presented by Sara Anastas, MD, at the 2019 ASCRS-ASOA annual meeting examine potential management options for these patients.

The retrospective study included data from 17 patients (31 eyes) referred for topography between 2008-2016. Only patients who were age 18 years or younger and followed for ≥2 years after topography were included. Patients were grouped according to progression to PKP or CXL, or no surgical treatment. Mean anterior keratometry (AKm), posterior keratometry (PKm), and thinnest pachymetry point (TPP) of Pentacam topography were analyzed.

In 42% (13/31) of patients referred due to clinical suspicion of keratoconus, surgical intervention with PKP (7 pediatric eyes) or CXL (6 pediatric eyes) was needed. Patients who required PKP were significantly different (P < 0.01) than the other groups in AKm (mean = 54.1), PKm (mean = -8.14), and TPP (mean = 416.7). No significant differences were found between the CXL and control groups (AKm = 46.7, PKm = -6.8, TPP = 470.8 and AKm = 45.3, PKm = -6.7, TPP = 532, respectively).

The authors concluded that CXL-treated eyes did not have steeper AKm, PKm, and TPP, likely as a result of early referral and intervention before the need for PKP. Early referral should be considered in pediatric patients with clinical suspicion of keratoconus.

Reference:

Anastas S, Zaidman GW. Topographic findings in children with keratoconus. Paper presented at: ASCRS-ASOA annual meeting; May 5, 2019; San Diego, CA.