Marty A-S, Jurkiewicz T, Febvay C, Mouchel R, Burillon C
Clinique ophtalmologique Thiers, 330, avenue Thiers, 33100 Bordeaux, France.
Centre Vendôme, 13, rue Tronchet, 69006 Lyon, France; Hospices civils de Lyon, hôpital Pierre-Wertheimer, 59, boulevard Pinel, 69500 Bron, France.
J Fr Ophtalmol. 2021 Jun;44(6):828-834. doi: 10.1016/j.jfo.2020.11.012. Epub 2021 Apr 9.
In adults, the management of keratoconus has evolved in recent years to achieve a well-codified treatment algorithm. The technique of cross-linking (CXL) has allowed us to stabilize the progression of keratoconus and has been largely developed. It is very effective, with few postoperative complications. Currently, there is no specific keratoconus management protocol for children. As we already know that keratoconus usually evolves more rapidly in children, we might consider whether a stabilizing treatment should be proposed as first-line therapy at the time of diagnosis. We carried out a retrospective study including patients less than 18 years of age with keratoconus who consulted the ophthalmology department at Edouard Herriot hospital in Lyon between 2013 and 2017. The main study parameter was whether or not CXL was performed. The other parameters were gender, age, ethnicity, eye rubbing, presence or absence of atopic disease, maximum keratometry (Kmax), minimal pachymetry, best corrected visual acuity (BCVA) and spherical equivalent. Forty-eight eyes of 34 patients were included. We found that two-thirds of the patients were Caucasian boys. Half of the patients had allergies, and over 60% of patients rubbed their eyes regularly. Only six percent of patients had a family history of keratoconus. The mean age of the patients was 14 (7-18) years at the time of diagnosis. Thirty-four eyes of 22 patients underwent CXL, for a total of 71% of our cohort. No postoperative complications occurred. After CXL, there was no significant difference in minimum pachymetry (455.6±37.25μm vs. 453.45±42.6μm after treatment (P=0.71)) or Kmax (50.23±7.17D vs. 50.99±7.01D after treatment (P=0.058)). There was a significant improvement in BCVA (from 0.30±0.3LogMar to 0.17±0.17LogMar after CXL (P=0.024)) and spherical equivalent (-1.91±2.1D to -2.54±1.89D after treatment (P=0.009)). The mean duration of follow-up was 32.2 months (12-59). CXL shows long-term disease stabilization in children with keratoconus. Nevertheless, this technique is indicated only for progressive keratoconus. Early diagnosis and management are essential in this population where the disease is rapidly changing. Treatment of atopy and performance of corneal topography when a child has irregular astigmatism should become automatic for early detection of this disease.
近年来，成人圆锥角膜的治疗方法不断发展，形成了一套完善的治疗方案。交联（CXL）技术使我们能够稳定圆锥角膜的进展，并且得到了很大程度的发展。它非常有效，术后并发症很少。目前，尚无针对儿童圆锥角膜的特定治疗方案。由于我们已经知道圆锥角膜在儿童中通常进展更快，因此我们可能会考虑在诊断时是否应将稳定治疗作为一线治疗方法。我们进行了一项回顾性研究，纳入了2013年至2017年间在里昂爱德华·埃里奥医院眼科就诊的18岁以下圆锥角膜患者。主要研究参数是是否进行了CXL。其他参数包括性别、年龄、种族、揉眼情况、是否存在特应性疾病、最大角膜曲率（Kmax）、最小角膜厚度、最佳矫正视力（BCVA）和等效球镜度。共纳入34例患者的48只眼。我们发现三分之二的患者是白人男孩。一半的患者有过敏史，超过60%的患者经常揉眼。只有6%的患者有圆锥角膜家族史。患者诊断时的平均年龄为14（7 - 18）岁。22例患者的34只眼接受了CXL，占我们队列的71%。未发生术后并发症。CXL后，最小角膜厚度（治疗前455.6±37.25μm，治疗后453.45±42.6μm，P = 0.71）或Kmax（治疗前50.23±7.17D，治疗后50.99±7.01D，P = 0.058）无显著差异。BCVA有显著改善（CXL后从0.30±0.3LogMar提高到0.17±0.17LogMar，P = 0.024），等效球镜度也有改善（治疗后从 - 1.91±2.1D变为 - 2.54±1.89D，P = 0.009）。平均随访时间为32.2个月（12 - 59个月）。CXL显示圆锥角膜患儿疾病长期稳定。然而，该技术仅适用于进行性圆锥角膜。在这种疾病变化迅速的人群中，早期诊断和治疗至关重要。当儿童有不规则散光时，治疗特应性疾病和进行角膜地形图检查应成为早期发现这种疾病的常规操作。
