Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
UCLA Stein Eye Institute, Los Angeles, CA, USA.
BMC Ophthalmol. 2024 Oct 21;24(1):463. doi: 10.1186/s12886-024-03714-0.
Keratoconus in children is often more severe and rapidly progressive compared to adults. While Scheimpflug imaging (Pentacam) improves screening, there are no established pediatric guidelines. Due to challenges in diagnosis, we aimed to correlate clinical factors with abnormal imaging results to aid in the development of screening protocols.
A single-center retrospective cohort analysis of patients 3-18 years screened for keratoconus with ophthalmic examination and initial Scheimpflug imaging between 2021 to 2023. Scheimpflug indices including final D, ART max, and calculated CAIRO 8, which is a corneal metric combining pachymetry, ART max, and elevation, were compared to published pediatric ranges for normal and keratoconus corneas.
Seventy-eight patients (11.8 ± 3.9 years) were screened with the majority referred due to high and/or progressive astigmatism (74 patients, 94%). Forty-nine patients (63%) were male and 48 (62%) self-reported Hispanic ethnicity. Average astigmatism was 4.9 ± 1.8 D and 86% had with-the-rule astigmatism. Fourteen patients (18%) had corneal findings on slit lamp. Average LogMAR CDVA was 0.243 ± 0.274 D. By Pentacam, 55 (70%) patients had ≥ 1 indeterminate or keratoconus value. Patients stratified as keratoconus by all parameters were older (15 vs. 11 years, p = 0.015-0.02), had worse visual acuity (p < 0.0001), and were more likely to have oblique astigmatism (0.0002-< 0.0001) and corneal abnormalities on examination (p < 0.00001) compared to eyes with normal or indeterminate indices.
Older age, lower visual acuity, oblique astigmatism, and corneal findings were more commonly found in patients with abnormal screening Pentacam. Most patients clinically suspicious for keratoconus had ≥ 1 indeterminate/abnormal indices. Future studies will follow these patients to identify clinical risk factors for progression.
与成年人相比，儿童的圆锥角膜通常更严重且进展更快。Scheimpflug 成像（Pentacam）提高了筛查效果，但目前尚无针对儿童的既定指南。由于诊断方面的挑战，我们旨在将临床因素与异常成像结果相关联，以帮助制定筛查方案。
对 2021 年至 2023 年间在单中心接受眼科检查和初始 Scheimpflug 成像筛查的 3-18 岁患者进行回顾性队列分析。Scheimpflug 指数，包括最终的 D 值、最大的 ART 值和计算的 CAIRO 8（角膜参数，结合了角膜厚度、最大的 ART 值和高度），与已发表的儿童正常和圆锥角膜角膜的正常值进行了比较。
对 78 名患者（11.8±3.9 岁）进行了筛查，大多数患者（74 名，94%）因高度和/或进展性散光而被转诊。49 名患者（63%）为男性，48 名（62%）为自报西班牙裔。平均散光为 4.9±1.8 D，86%为顺规散光。14 名患者（18%）在裂隙灯下有角膜发现。平均 LogMAR CDVA 为 0.243±0.274 D。通过 Pentacam，55 名患者（70%）有≥1 个不确定或圆锥角膜值。通过所有参数分层为圆锥角膜的患者年龄更大（15 岁比 11 岁，p=0.015-0.02），视力更差（p<0.0001），更有可能有斜散光（0.0002-<0.0001）和角膜异常（p<0.00001）。
在筛查 Pentacam 异常的患者中，年龄较大、视力较差、斜散光和角膜异常更常见。大多数临床上疑似圆锥角膜的患者有≥1 个不确定/异常指数。未来的研究将对这些患者进行随访，以确定进展的临床危险因素。
