Cornea Consultant, Aravind Eye Hospital & Postgraduate Institute, Tirunelveli, Tamil Nadu, India.
Prof of Ophthalmology, Cornea, Cataract & Refractive Services, Dr R P Centre for Ophthalmic Sciences, AIIMS, New Delhi, India.
Indian J Ophthalmol. 2021 Feb;69(2):214-225. doi: 10.4103/ijo.IJO_1263_20.
Keratoconus is an ectatic corneal disease characterized by progressive stromal thinning, irregular astigmatism, and defective vision. It can be unilateral or bilateral with asymmetric presentation. It starts at puberty and either progresses rapidly to an advanced stage of the disease or stops in case of delayed onset and slow progression. Pediatric keratoconus is more aggressive than in adults and the management protocols differ because of various rationales such as accelerated progression, advanced stage of disease at the time of diagnosis and co-morbidities. It poses a burden to the society as it affects the quality of life, social, and educational development in children. Hence early diagnosis, recognition of progression, and timely intervention with collagen crosslinking is imperative to arrest the worsening. Association with systemic syndromes and ocular comorbidities can be of concern in pediatric keratoconus. Severe ocular allergy when associated hastens progress and complicates timely intervention of crosslinking treatment and compliance to contact lens wear. Keratoplasty in pediatric keratoconus has good outcomes but can encounter frequent suture-related concerns. This article discusses the epidemiology, etiopathogenesis, clinical challenges, and current perspectives of management of pediatric keratoconus.
圆锥角膜是一种进行性的角膜扩张疾病，其特征为基质变薄、不规则散光和视力受损。它可以是单侧或双侧的，表现为不对称。它始于青春期，要么快速进展到疾病的晚期，要么在发病延迟和进展缓慢的情况下停止。儿科圆锥角膜比成人更具侵袭性，由于各种原因，如进展加速、诊断时疾病已处于晚期以及合并症等，管理方案有所不同。它给社会带来了负担，因为它会影响儿童的生活质量、社交和教育发展。因此，早期诊断、认识进展以及及时进行胶原交联干预以阻止病情恶化至关重要。与全身性综合征和眼部合并症的关联在儿科圆锥角膜中可能值得关注。与严重眼部过敏相关的疾病会加速进展，并使交联治疗的及时干预和对隐形眼镜佩戴的依从性复杂化。在儿科圆锥角膜中进行角膜移植的效果良好，但可能会经常出现与缝线相关的问题。本文讨论了儿科圆锥角膜的流行病学、病因发病机制、临床挑战以及当前的管理观点。
