Pediatric keratoconus in a tertiary referral center: prevalence, presentation, risk factors and treatment

Session Details

Session Title: Cornea - Medical

Session Date/Time: Monday 07/09/2015 | 08:00-10:30

Paper Time: 08:12

Venue: Room 17

First Author: : J.Antoun LEBANON

Co Author(s): :    E. Slim   H. El Rami   A. Hemade   J. Bleik   C. Cherfan   E. Jarade     

Abstract Details

Purpose:

We report the prevalence, clinical manifestation, staging and risk factors of pediatric keratoconus (PKC) in a tertiary referral eye hospital in Beirut, Lebanon. We also present the safety and outcomes of our plan of treatment based on corneal collagen cross-linking (CXL), intra corneal ring segments (ICRS) implantation, and phakic intraocular lens (IOL).

Setting:

Beirut Eye Specialist Hospital, Beirut, Lebanon

Methods:

Consecutive keratoconus (KC) patients with age less than 14 years were recruited in this prospective study between 2010 and 2014. The prevalence of PKC was assessed among pediatric patients and among keratoconus patients of all ages. Detailed medical history was obtained with full medical assessment of patients, including staging, UCVA and BCVA, corneal topography and pachymetry, was performed at initial presentation and at different follow up visits. All eyes were initially treated with standard CXL. ICRS insertion was reserved to a subgroup of patients with poor BCVA and severe anisometropia; phakic IOL was reserved for severe anisometropia after ICRS-CXL treatment.

Results:

Prevalence of PKC among pediatric patients was 0.47%, and prevalence of PKC among all KC patients was 2.65%. Initial presentation was: routine checkup (2/14), allergic conjunctivitis (1/14), loss of vision (9/14); leukocorea-hydrops (2/14). Ten eyes (45.5%) had a stage 1 keratoconus, 10 eyes (45.5%) had a stage 2 keratoconus and 2 eyes (9.0%) had a stage 4 keratoconus. Ten eyes underwent CXL alone. 12 eyes underwent ICRS prior to CXL to enhance BCVA. One eye underwent phakic IOL after ICRS/CXL to treat severe anisometropia. No progression of keratoconus was noted during the entire period and all procedures were well tolerated.

Conclusions:

Pediatric keratoconus is an existing condition and may present with different clinical manifestations. Detailed clinical exam, retinoscopic exam and corneal topography are affordable tools to detect KC in pediatric population. Increased awareness of KC among pediatric patients should be practiced mainly with the presence of family history of KC, eye rubbing, low BCVA, leukocoria, and high astigmatism. We recommend performing corneal CXL in all pediatric keratoconus, regardless of evidence of progression. ICRS surgery proved to be safe and effective in enhancing BCVA and decreasing spherical equivalence. Phakic IOL is effective in treating severe anisometropia after ICRS and CXL.

Financial Interest:

NONE