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  • Review Article
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Diagnosis and management of keratoconus in the paediatric age group: a review of current evidence

Eye volume 37, pages 3718–3724 (2023)Cite this article

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Abstract

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。

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Data availability

Liam Price, as the corresponding author have had full access to all the data in this review article and had final decision to submit for publication.

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Acknowledgements

Supported in part by the National Institute for Health Research (NIHR) Efficacy and Mechanism Evaluation Programme (reference. [14, 18, 23]), an MRC and NIHR partnership. The trial was otherwise supported in part by the NIHR Moorfields Biomedical Research Centre and NIHR Moorfields Clinical Research Facility. The funding organisation had no role in design or conduct of this research.

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This review article received no specific funding.

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Authors and Affiliations

  1. Moorfields Eye Hospital, London, United Kingdom

    Liam D. Price

  2. NIHR Moorfields Biomedical Research Centre, Moorfields Eye Hospital, London, United Kingdom

    Daniel F. P. Larkin

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L.P. and D.L. had equal involvement in producing this manuscript in all of the following criteria: 1. Conceived and/or designed the work that led to the submission, acquired data, and/or played an important role in interpreting the results. 2. Drafted or revised the manuscript. 3. Approved the final version. 4. Agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

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Correspondence to Liam D. Price.

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Price, L.D., Larkin, D.F.P. Diagnosis and management of keratoconus in the paediatric age group: a review of current evidence. Eye 37, 3718–3724 (2023). https://doi.org/10.1038/s41433-023-02600-1

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