The diagnosis and management of keratoconus in the paediatric age group presents additional challenges to those encountered in adults. The most significant of these, encountered in some young patients, are delayed presentation of unilateral disease, more advanced disease at diagnosis, difficulty in obtaining reliable corneal imaging, faster rates of disease progression and challenges in contact lens management. The stabilisation effect of corneal cross-linking (CXL), more extensively studied in adults with randomised trials and long-term follow-up, has been much less rigorously examined in children and adolescents. The high heterogeneity of published studies in younger patients, particularly in the choice of tomography parameters designated as primary outcome measures and the definitions of progression, indicates that improved standardisation for future studies on CXL will be necessary. There is no evidence that corneal transplant outcomes in young patients are poorer than those in adults. This review provides a current perspective on the optimal diagnosis and treatment of keratoconus in children and adolescents.
摘要: 儿童年龄组圆锥角膜的诊断和治疗相较于成人面临更大的挑战。在一些年轻患者中, 最重要的是单眼患病的延迟表现、诊断时处于晚期的疾病、难以获得可靠的角膜图像、疾病进展速度快以及接触镜管理方面的挑战。通过随机试验和长期随访, 成人角膜交联术 (CXL) 的稳定作用已得到了广泛研究, 但关于儿童和青少年的研究要少得多。已发表的针对年轻患者的研究具有高度异质性, 尤其在选择指定断层扫描参数作为首要结果测定和进展定义方面, 这表明有必要改善未来CXL研究的标准化。没有证据表明年轻患者的角膜移植效果比成人更差。本综述对儿童和青少年圆锥角膜的最佳诊断和治疗提供了目前的观点。.
© 2023. The Author(s), under exclusive licence to The Royal College of Ophthalmologists.