Diagnosis and management of paediatric keratoconus in the Indian population

Session Details

Session Title: Cross-Linking

Session Date/Time: Tuesday 25/09/2018 | 14:00-16:00

Paper Time: 14:18

Venue: Room A3, Podium 3

First Author: : A.Sriram INDIA

Co Author(s): :    S. Mohan   M. Banerjee                 

Abstract Details

Purpose:

To detect keratoconus and identify the associated risk factors in children presenting with astigmatism and to evaluate the safety and efficacy of accelerated collagen crosslinking (CXL) in pediatric age group.

Setting:

RAJAN EYE CARE HOSPITAL PRIVATE LIMITED CHENNAI INDIA

Methods:

It was a prospective interventional study. 700 eyes of 350 children below 18 years with astigmatism of ±1.50 Dioptre or greater were screened for presence of clinical sign and/or topographic evidence of keratoconus. Best corrected visual acuity (BCVA), detailed ophthalmic examination along with corneal topography & PENTACAM was done for all cases . Eyes documented with progression > 0.5 D in a period of 3 months were selected for accelerated collagen crosslinking. After the initial three postoperative follow ups,visual acuity and refraction was checked at first week, first and third months. Pentacam was repeated only at the final follow up.

Results:

Out of 700 eyes screened, 32 eyes of 22 patients were diagnosed with keratoconus of which 25 eyes of 15 patients with progression underwent accelerated CXL without any complications.Mean age at presentation was 12.93±3.8 years.The major risk factor associated was eye rubbing following allergic conjunctivitis.Post operatively, there was a statistically significant decrease in the cylindrical component(-4.1±2.7 dioptres vs -3.7±2.6 diopters), in Flat Keratometry K1 (46.5±5.1 vs 45.7±4.7 diopters), Average Keratometry K mean (48.3±5.6 vs 47.9±5.5 diopters )and central corneal thickness (505.4±44.7 vs 482.4 ±51.8 microns).Steep keratometry (K2) and Kmax remained the same at baseline and 3 months postoperative period.

Conclusions:

Keratoconus may present as an underlying pathology in children with significant astigmatism and can coexist with allergic conjunctivitis. Even in the absence of clinical signs, corneal imaging should be performed to rule out keratoconus in such cases. In our study, Accelerated Corneal collagen crosslinking has been found to be safe and effective in the treatment of pediatric keratoconus. It improves the topographic parameters and stabilizes the progression without any major side effects.Longterm studies with larger sample size and longer time of follow up is required for further insight.

Financial Disclosure:

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