Global R&D, Menicon Co. Ltd, Nagoya, Japan.
Department of Optometry and Vision, Faculty of Optics and Optometry, Universidad Complutense de Madrid, Madrid, Spain.
Cont Lens Anterior Eye. 2022 Jun;45(3):101559. doi: 10.1016/j.clae.2021.101559. Epub 2022 Jan 4.
Keratoconus is a bilateral and asymmetric disease which results in progressive thinning and steeping of the cornea leading to irregular astigmatism and decreased visual acuity. Traditionally, the condition has been described as a noninflammatory disease; however, more recently it has been associated with ocular inflammation. Keratoconus normally develops in the second and third decades of life and progresses until the fourth decade. The condition affects all ethnicities and both sexes. The prevalence and incidence rates of keratoconus have been estimated to be between 0.2 and 4,790 per 100,000 persons and 1.5 and 25 cases per 100,000 persons/year, respectively, with highest rates typically occurring in 20- to 30-year-olds and Middle Eastern and Asian ethnicities. Progressive stromal thinning, rupture of the anterior limiting membrane, and subsequent ectasia of the central/paracentral cornea are the most commonly observed histopathological findings. A family history of keratoconus, eye rubbing, eczema, asthma, and allergy are risk factors for developing keratoconus. Detecting keratoconus in its earliest stages remains a challenge. Corneal topography is the primary diagnostic tool for keratoconus detection. In incipient cases, however, the use of a single parameter to diagnose keratoconus is insufficient, and in addition to corneal topography, corneal pachymetry and higher order aberration data are now commonly used. Keratoconus severity and progression may be classified based on morphological features and disease evolution, ocular signs, and index-based systems. Keratoconus treatment varies depending on disease severity and progression. Mild cases are typically treated with spectacles, moderate cases with contact lenses, while severe cases that cannot be managed with scleral contact lenses may require corneal surgery. Mild to moderate cases of progressive keratoconus may also be treated surgically, most commonly with corneal cross-linking. This article provides an updated review on the definition, epidemiology, histopathology, aetiology and pathogenesis, clinical features, detection, classification, and management and treatment strategies for keratoconus.
圆锥角膜是一种双侧和不对称的疾病，导致角膜渐进性变薄和陡峭，导致不规则散光和视力下降。传统上，这种情况被描述为非炎症性疾病；然而，最近它与眼内炎症有关。圆锥角膜通常在生命的第二和第三个十年发展，并在第四个十年之前进展。这种情况影响所有种族和性别。圆锥角膜的患病率和发病率估计为每 10 万人中有 0.2 至 4790 例，每 10 万人/年有 1.5 至 25 例，发病率最高的通常发生在 20 至 30 岁的人群和中东和亚洲种族。进行性基质变薄、前界膜破裂以及随后的中央/旁中央角膜扩张是最常见的组织病理学发现。圆锥角膜的家族史、揉眼、湿疹、哮喘和过敏是发展为圆锥角膜的危险因素。在其早期阶段检测到圆锥角膜仍然是一个挑战。角膜地形学是圆锥角膜检测的主要诊断工具。然而，在初期病例中，使用单个参数来诊断圆锥角膜是不够的，除了角膜地形学外，角膜厚度和高阶像差数据现在也经常使用。圆锥角膜的严重程度和进展可以基于形态特征和疾病演变、眼部体征以及基于指数的系统进行分类。圆锥角膜的治疗取决于疾病的严重程度和进展。轻度病例通常用眼镜治疗，中度病例用隐形眼镜治疗，而不能用巩膜隐形眼镜治疗的严重病例可能需要角膜手术。轻度至中度进展性圆锥角膜也可以手术治疗，最常见的是角膜交联。本文对圆锥角膜的定义、流行病学、组织病理学、病因和发病机制、临床特征、检测、分类以及管理和治疗策略进行了更新综述。
