Gupta Yogita, Saxena Rohit, Jhanji Vishal, Maharana Prafulla K, Sinha Rajesh, Agarwal Tushar, Titiyal Jeewan S, Sharma Namrata
Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, Delhi, India.
University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
J Ophthalmol. 2022 Feb 7;2022:4021288. doi: 10.1155/2022/4021288. eCollection 2022.
The Global Delphi Panel of Keratoconus (KC) and Ectatic Diseases formulated management guidelines for KC in 2015. The aim of this study was to evaluate management outcomes in pediatric KC.
Prospective, interventional study was conducted at a tertiary care hospital including KC patients aged <18 years. Based on disease severity and progression of disease, patients were prescribed either glasses or contact lenses (CLs) or underwent corneal collagen crosslinking (CXL), deep anterior lamellar keratoplasty (DALK), or penetrating keratoplasty (PK). . Best corrected visual acuity (BCVA), manifest cylinder, maximum keratometry, thinnest corneal thickness, total higher order aberrations, and corneal hysteresis at baseline and 12 and 24 months.
116 eyes of 62 patients with a mean age of 14.76 ± 2.77 years were included. 32.8% of the eyes ( = 38) achieved satisfactory BCVA with glasses/CLs only. Corneal collagen crosslinking (CXL) was performed in 43.1% of the eyes ( = 50) with progressive KC and halting of progression was noted in 83.3% ( = 35) of the eyes at 2 years. 7.7% of the eyes ( = 9) were managed for acute hydrops. DALK and PK were successfully performed in 9.5% ( = 11) and 6.9% ( = 8) of the eyes with BCVA of 0.14 ± 0.09 and 0.08 ± 0.12 at 2 years, respectively.
Pediatric KC cases with progression show good visual and aberrometric outcomes and halting of progression after CXL. DALK and PK have good outcomes. The global consensus guidelines showed good clinical utility in pediatric patients. Presence of VKC did not have an impact on the outcomes of CXL in pediatric patients.
圆锥角膜（KC）和扩张性疾病全球德尔菲小组于2015年制定了KC的管理指南。本研究的目的是评估儿童KC的管理结果。
在一家三级护理医院进行了一项前瞻性干预研究，纳入年龄小于18岁的KC患者。根据疾病严重程度和病情进展，为患者开具眼镜或隐形眼镜（CL），或进行角膜胶原交联（CXL）、深板层角膜移植术（DALK）或穿透性角膜移植术（PK）。在基线、12个月和24个月时测量最佳矫正视力（BCVA）、明显柱镜度数、最大角膜曲率、最薄角膜厚度、总高阶像差和角膜滞后。
纳入62例患者的116只眼，平均年龄为14.76±2.77岁。32.8%的眼（n = 38）仅通过眼镜/CL获得了满意的BCVA。43.1%的进展性KC眼（n = 50）进行了角膜胶原交联（CXL），2年后83.3%（n = 35）的眼病情进展停止。7.7%的眼（n = 9）接受了急性角膜水肿的治疗。2年后，DALK和PK分别成功应用于9.5%（n = 11）和6.9%（n = 8）的眼，BCVA分别为0.14±0.09和0.08±0.12。
进展性儿童KC病例在CXL后显示出良好的视力和像差测量结果，病情进展停止。DALK和PK效果良好。全球共识指南在儿童患者中显示出良好的临床实用性。春季角结膜炎（VKC）的存在对儿童患者CXL的结果没有影响。
