Pediatric Keratoconus: Clinical And Therapeutic Particularities

To describe clinical presentation, progression rate and treatment outcome of pediatric keratoconus in southern Tunisia.

In this retrospective study, we evaluated all patients with keratoconus 18 years or younger  diagnosed at the Habib Bourguiba Hospital, Sfax, Tunisia, between August 2013 and February 2020. Patients with advanced keratoconus at the surgical stage were excluded

Patients with pediatric keratoconus were evaluated for initial presentation, uncorrected distance visual acuity, corrected distance visual acuity, keratoconus stage, corneal topography, pachymetry and different follow-up visits.

A total of 20 patients (38 eyes), with a mean age of 12.8 years, were included. Eye rubbing was present in 80% of patients. Best corrected visual acuity was 0.37 logMAR. Corneal topography showed central cone in 13 eyes. Mean Kmax was 54.6 D, and the mean central pachymetry was 429.9 µm. According to the Amsler-Krumeich classification, 47.4% of the eyes were classified in stage 4 of the disease. Ten eyes benefited from corneal cross-linking and for optical correction, 22 eyes were equipped with rigid gas permeable lenses and 16 eyes with glasses. After an average follow-up of 13.8 months, we noted a stabilization of 80% of the eyes treated with CXL against an evolution of 64.3% of the eyes not treated with CXL.

Pediatric keratoconus is often diagnosed at a more advanced stage than in adults. Early diagnosis by carrying out a corneal topography is essential in any child with astigmatism of recent onset or evolution. Monitoring must be as close in order to offer appropriate treatment.