Department of Ophthalmology, Shamir Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel.
Cornea. 2021 Oct 1;40(10):1322-1329. doi: 10.1097/ICO.0000000000002632.
To evaluate the ABCD grading system in pediatric keratoconus.
A retrospective cohort analysis of all children with keratoconus followed up at the Shamir medical center between 2010 and 2017. A recommendation by the treating physician to undergo corneal crosslinking (CXL) was used as an estimate for clinically significant disease progression. The ABCD grading was not available to the treating physician and was computed post hoc. The ABCD grading was compared between patients who required CXL with those who did not. A single eye of each patient was included.
Fifty eyes of 50 children were analyzed. The mean age at presentation was 15.56 ± 1.36 years. In 23 eyes, progression of keratoconus was recorded and CXL was performed (CXL-group). On presentation, the stable and CXL groups did not differ significantly in their clinical parameters. In the CXL-group, a statistically significant increase was seen in the ABCD staging (P < 0.001). In the stable group, the ABCD staging did not change significantly in parallel visits (P = 0.87). An increase of 1 point in the sum of the ABCD staging showed a 5-fold risk for undergoing CXL (odds ratio = 5.28; 95% CI, 1.82-15.34). There was no significant change in the Amsler-Krumeich classification in the CXL group.
Among a cohort of pediatric patients with keratoconus, worsening in the ABCD grading was associated with disease progression, whereas no significant change was demonstrated in the Amsler-Krumeich classification The ABCD grading system is a useful tool for initial assessment of disease progression in the pediatric population, in which early recognition is of paramount importance.
评估 ABCD 分级系统在儿童圆锥角膜中的应用。
对 2010 年至 2017 年在沙米尔医疗中心接受随访的所有儿童圆锥角膜患者进行回顾性队列分析。以治疗医生建议行角膜交联术（CXL）作为临床显著疾病进展的估计。ABCD 分级在治疗医生处不可用，是事后计算的。比较需要 CXL 的患者和不需要 CXL 的患者的 ABCD 分级。每位患者的单眼均纳入研究。
共分析了 50 例 50 只眼的患者。就诊时的平均年龄为 15.56 ± 1.36 岁。23 只眼记录到圆锥角膜进展，并进行了 CXL（CXL 组）。在就诊时，稳定组和 CXL 组在临床参数上无显著差异。在 CXL 组，ABCD 分级有显著的统计学增加（P < 0.001）。在稳定组，平行随访时 ABCD 分级无显著变化（P = 0.87）。ABCD 分级总分增加 1 分，行 CXL 的风险增加 5 倍（比值比 = 5.28；95%可信区间，1.82-15.34）。CXL 组的 Amsler-Krumeich 分级无显著变化。
在儿童圆锥角膜患者队列中，ABCD 分级的恶化与疾病进展相关，而 Amsler-Krumeich 分级无显著变化。ABCD 分级系统是评估儿科人群疾病进展的有用工具，早期识别至关重要。
