Skip to main content
SpringerLink
Log in

Keratoconus in Children

  • Chapter
  • First Online:
Keratoconus

Part of the book series: Essentials in Ophthalmology ((ESSENTIALS))

Abstract

Keratoconus typically has its onset at puberty and progresses until the third to fourth decade of life, when it usually stabilizes. In pediatric patients keratoconus is often more advanced at diagnosis and its progression may be more frequent and more rapid with a sevenfold higher risk of requiring corneal grafting. Childhood onset cases have a more aggressive progression than those of later onset; therefore, detection of progressive keratoconus in early stages of the disease is necessary to prevent severe visual impairment. Keratoconus represents one of the most common causes of corneal transplantation in children causing about 15–20 % of all corneal transplants in children.

The diagnosis of keratoconus in children is often made late. It depends on the scarcity of functional complaints in children, especially before the age of 8. Corneal cross-linking is actually the standard treatment for patients affected by keratoconus. In children as well as in adolescents it is actually indicated as soon as the diagnosis has been made without documented clinical progression because younger patients usually show a fast progression of keratoconus.

Deep anterior lamellar keratoplasty appears the “best choice” in surgical treatment.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 109.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 159.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Rabinowitz YS. Keratoconus. Surv Ophthalmol. 1998;42:297–319.

    Article  CAS  PubMed  Google Scholar 

  2. McAnena L, O’Keefe M. Corneal collagen crosslinking in children with keratoconus. J AAPOS. 2015;19:228–32.

    Article  PubMed  Google Scholar 

  3. Leoni-Mesplie S, Mortemosque B, Touboul D, et al. Scalability and severity of keratoconus in children. Am J Ophthalmol. 2012;154:156–62.

    Article  Google Scholar 

  4. Caporossi A, Mazzotta C, Baiocchi S, et al. Riboflavin UVA-induced corneal collagen cross-linking in pediatric patients. Cornea. 2012;31:227–31.

    Article  PubMed  Google Scholar 

  5. Reeves SW, Stinnett S, Adelman RA, et al. Risk factors for progression to penetrating keratoplasty in patients with keratoconus. Am J Ophthalmol. 2005;140:607–11.

    Article  PubMed  Google Scholar 

  6. Chatzis N, Hafezi F. Progression of keratoconus and efficacy of pediatric (corrected) corneal collagen cross-linking in children and adolescents. J Refract Surg. 2012;28:753–8.

    Article  PubMed  Google Scholar 

  7. Al Suhaiba Al Suhaibani AH, Al-Rajhi AA, Al-Motowa S, Wagoner MD. Inverse relationship between age and severity and sequelae of acute corneal hydrops associated with keratoconus. Br J Ophthalmol. 2007;91(7):984–5.

    Article  Google Scholar 

  8. Ertan A, Muftuoglu O. Keratoconus clinical findings according to different age and gender groups. Cornea. 2008;27(10):1109–13.

    Article  PubMed  Google Scholar 

  9. Gabrić N, Dekaris I, Vojniković B, Karaman Z, Mravicić I, Katusić J. Corneal transplantation in children. Coll Antropol. 2001;25(Suppl):17–22.

    PubMed  Google Scholar 

  10. Beltaief O, Farah H, Kamoun R, Ben Said A, Ouertani A. Penetrating keratoplasty in children. Tunis Med. 2003;81(7):477–81.

    PubMed  Google Scholar 

  11. Slim EA, Jarade EF, Charanek BM, Antoun JS, Hemade AI, Awada SH, Fakhoury HW, Cherfan CG. Acute corneal hydrops mimicking infectious keratitis as initial presentation of keratoconus in a 10-year-old child. Case Rep Ophthalmol Med. 2015;2015:308348.

    PubMed  PubMed Central  Google Scholar 

  12. Javadi MA, Rafee'i AB, Kamalian N, Karimian F, Ja'farinasab MR, Yazdani S. Concomitant keratoconus and macular corneal dystrophy. Cornea. 2004;23(5):508–12.

    Article  PubMed  Google Scholar 

  13. Cremona FA, Ghosheh FR, Rapuano CJ, Eagle Jr RC, Hammersmith KM, Laibson PR, Ayres BD, Cohen EJ. Keratoconus associated with other corneal dystrophies. Cornea. 2009;28(2):127–35.

    Article  PubMed  Google Scholar 

  14. Courage ML, Adams RJ, Reyno S, Kwa PG. Visual acuity in infants and children with Down syndrome. Dev Med Child Neurol. 1994;36:586–93.

    Article  CAS  PubMed  Google Scholar 

  15. Watt T, Robertson K, Jacobs RJ. Refractive error, binocular vision and accommodation of children with Down syndrome. Clin Exp Optom. 2015;98(1):3–11.

    Article  PubMed  Google Scholar 

  16. Howard S, Raine J, Dattani M. Corneal rupture in a child with Down syndrome and hyperthyroidism. BMJ Case Rep. 2009; 2009. pii: bcr08.2008.0842. doi: 10.1136/bcr.08.2008.0842. Epub 2009 Mar 5.

    Google Scholar 

  17. Lowell FC, Carroll JM. A study of the occurrence of atopic traits in patients with keratoconus. J Allergy Clin Immunol. 1970;46:32–9.

    CAS  Google Scholar 

  18. Kaya V, Karakaya M, Utine CA, Albayrak S, Oge OF, Yilmaz OF. Evaluation of the corneal topographic characteristics of keratoconus with orbscan II in patients with and without atopy. Cornea. 2007;26(8):945–8.

    Article  PubMed  Google Scholar 

  19. Copeman PWM. Eczema and keratoconus. BMJ. 1965;2:977–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Gasset AR, Hinson WA, Frias JL. Keratoconus and atopic disease. Ann Ophthalmol. 1978;10:991–4.

    CAS  PubMed  Google Scholar 

  21. Kok YO, Tan GF, Loon SC. Review: keratoconus in Asia. Cornea. 2012;31(5):581–93.

    Article  PubMed  Google Scholar 

  22. Lapid-Gortzak R, Rosen S, Weitzman S, et al. Videokeratography findings in children with vernal keratoconjunctivitis versus those of healthy children. Ophthalmology. 2002;109:2018–23.

    Article  PubMed  Google Scholar 

  23. Rehany U, Rumelt S. Corneal hydrops associated with vernal conjunctivitis as a presenting sign of keratoconus in children. Ophthalmology. 1995;102(12):2046–9.

    Article  CAS  PubMed  Google Scholar 

  24. Dharmaraj S, Leroy BP, Sohocki MM, Koenekoop RK, Perrault I, Anwar K, Khaliq S, Devi RS, Birch DG, De Pool E, Izquierdo N, Van Maldergem L, Ismail M, Payne AM, Holder GE, Bhattacharya SS, Bird AC, Kaplan J, Maumenee IH. The phenotype of Leber congenital amaurosis in patients with AIPL1 mutations. Arch Ophthalmol. 2004;122(7):1029–37.

    Article  CAS  PubMed  Google Scholar 

  25. Weleber RG, Francis PJ, Trzupek KM, Beattie C.Leber Congenital Amaurosis. In: Pagon RA, Adam MP, Ardinger HH, Wallace SE, Amemiya A, Bean LJH, Bird TD, Fong CT, Mefford HC, Smith RJH, Stephens K, editors.GeneReviews®[Internet]. Seattle (WA): University of Washington, Seattle; 1993-2016. 2004 Jul 7 [updated 2013 May 2].

    Google Scholar 

  26. Caporossi A, Mazzotta C, Baiocchi S, Caporossi T. Long-term results of riboflavin ultraviolet a corneal collagen cross-linking for keratoconus in Italy: the Siena eye cross study. Am J Ophthalmol. 2010;149:585–93.

    Article  CAS  PubMed  Google Scholar 

  27. Gomes JAP, Tan D, Rapuano CJ, et al. Global consensus on keratoconus and ectatic diseases. Cornea. 2015;34:359–69.

    Article  PubMed  Google Scholar 

  28. Mazzotta C, Balestrazzi A, Baiocchi S, Traversi C, Caporossi A. Stromal haze after combined riboflavin-UVA corneal collagen cross-linking in keratoconus: in vivo confocal microscopic evaluation. Clin Exp Ophthalmol. 2007;35:580–2.

    Article  PubMed  Google Scholar 

  29. Zamora KV, Males JJ. Polymicrobial keratitis after a collagen cross-linking procedure with postoperative use of a contact lens: a case report. Cornea. 2009;28(4):474–6.

    Article  PubMed  Google Scholar 

  30. Bikbova G, Bikbov M. Transepithelial corneal cross-linking by iontophoresis of riboflavin. Acta Ophthalmol. 2013;92:e30–4.

    Article  PubMed  Google Scholar 

  31. Mastropasqua L, Nubile M, Calienno R, Mattei PA, Pedrotti E, Salgari N, Mastropasqua R, Lanzini M. Corneal cross-linking: intrastromal riboflavin concentration in iontophoresis-assisted imbibitions versus traditional and transepithelial techniques. Am J Ophthalmol. 2014;157:623–30.

    Article  CAS  PubMed  Google Scholar 

  32. Buzzonetti L, Petrocelli G, Valente P, et al. Iontophoretic transepithelial cross-linking to halt keratoconus in pediatric cases: 15 month follow-up. Cornea. 2015;34:512–5.

    Article  PubMed  Google Scholar 

  33. Koppen C, Wouters K, Mathysen D, Rozema J, Tassignon MJ. Refractive and topographic results of benzalkonium chloride-assisted transepithelial crosslinking. J Cataract Refract Surg. 2012;38:1000–5.

    Article  PubMed  Google Scholar 

  34. Buzzonetti L, Petrocelli G. Transepithelial corneal cross linking in children. Early results. J Refract Surg. 2012;28:763–7.

    Article  PubMed  Google Scholar 

  35. Colin J. European clinical evaluation: use of Intacs for the treatment of keratoconus. J Cataract Refract Surg. 2006;32:747–55.

    Article  PubMed  Google Scholar 

  36. Zare MA, Hashemi H, Salari MR. Intracorneal ring segment implantation for the management of keratoconus: safety and efficacy. J Cataract Refract Surg. 2007;33:1886–91.

    Article  PubMed  Google Scholar 

  37. Vega-Estrada A, Alio JL, Brenner LF, Javaloy J, Plaza Puche AB, Barraquer RI, Teus MA, Murta J, Henriques J, Uceda-Montanes A. Outcome analysis of intracorneal ring segments for the treatment of keratoconus based on visual, refractive, and aberrometric impairment. Am J Ophthalmol. 2013;155:575–84.

    Article  PubMed  Google Scholar 

  38. Kankariya VP, Kymionis GD, Diakonis VF, Yoo SH. Management of pediatric keratoconus—evolving role of corneal collagen cross-linking: an update. Indian J Ophthalmol. 2013;61:435–40.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Colby K. Changing times for pediatric keratoplasty. J APPOS. 2008;12:223–4.

    Article  Google Scholar 

  40. Hovlykke M, Hjortdal J, Ehlers N, Nielsen K. Clinical results of 40 years of pediatric keratoplasty in a single university eye clinic. Acta Ophthalmol. 2013. doi:10.1111/aos.12198x.

    PubMed  Google Scholar 

  41. Huang C, O’Hara M, Mannis MJ. Primary pediatric keratoplasty: indications and outcomes. Cornea. 2009;28:1003–8.

    Article  PubMed  Google Scholar 

  42. Aasuri MK, Garg P, Gokhle N, Gupta S. Penetrating keratoplasty in children. Cornea. 2000;19:140–4.

    Article  CAS  PubMed  Google Scholar 

  43. Vanathi M, Panda A, Vengayil S, Chaudhuri Z, Dada T. Pediatric keratoplasty. Surv Ophthalmol. 2009;54:245–71.

    Article  CAS  PubMed  Google Scholar 

  44. Harding SA, Nishal KK, Upponi-Patil A, Fowler DJ. Indications and outcomes of deep anterior lamellar keratoplasty in children. Ophthalmology. 2010;117:2191–5.

    Article  PubMed  Google Scholar 

  45. Ashar JN, Pahuja S, Ramappa M, Vaddavalli PK, Chaurasia S, Garg P. Deep anterior lamellar keratoplasty in children. Am J Ophthalmol. 2013;155:570–4.

    Article  PubMed  Google Scholar 

  46. Buzzonetti L, Laborante A, Petrocelli G. Standardized big-bubble technique in deep anterior lamellar keratoplasty assisted by femtosecond laser. J Cataract Refract Surg. 2010;36:1631.6.

    Article  PubMed  Google Scholar 

  47. Buzzonetti L, Petrocelli G, Valente P. Big-bubble deep anterior lamellar keratoplasty assisted by femtosecond laser in children. Cornea. 2012;31:1083–6.

    Article  PubMed  Google Scholar 

  48. Agarwal A, Brubaker JW, Mamalis N, Kumar DA, Jacob S, Chinnamuthu S, Nair V, Prakash G, Meduri A, Agarwal A. Femtosecond-assisted lamellar keratoplasty in atypical Avellino corneal dystrophy of Indian origin. Eye Contact Lens. 2009;35(5):272–4. doi:10.1097/ICL.0b013e3181b3859c.

    Article  PubMed  Google Scholar 

  49. Buzzonetti L, Petrocelli G, Laborante A. Anterior lamellar keratoplasty assisted by IntraLase femtosecond laser in pediatric patient. Two years follow up. J Pediatr Ophthalmol Strabismus. 2010. doi:10.3928/01913913-20100507-01.

    PubMed  Google Scholar 

  50. Reinhart WJ, Musch DC, Jacobs DS, Lee WB, Kaufman SC, Shtein RM. Deep anterior lamellar keratoplasty as an alternative to penetrating keratoplasty. Ophthalmology. 2011;118:209–18.

    Article  PubMed  Google Scholar 

Download references

Compliance with Ethical Requirements

Conflict of Interest. Luca Buzzonetti, Paola Valente, and Gianni Petrocelli declare that they have no conflict of interest.

Informed Consent. All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000. Informed consent was obtained from all patients for being included in the study. No animal studies were performed by the authors for this chapter.

Author information

Authors and Affiliations

  1. Ophthalmology Department, Bambino Gesù IRCCS Children’s Hospital, Rome, Italy

    Luca Buzzonetti M.D., Paola Valente M.D. & Gianni Petrocelli M.D.

  2. Institute of Ophthalmology, Catholic University, Rome, Italy

    Luca Buzzonetti M.D.

Authors
  1. Luca Buzzonetti M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Paola Valente M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Gianni Petrocelli M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Luca Buzzonetti M.D. .

Editor information

Editors and Affiliations

  1. Keratoconus Unit Department of Refractive Surgery, Vissum Alicante, Alicante, Spain

    Jorge L. Alió

Rights and permissions

Reprints and permissions

Copyright information

© 2017 Springer International Publishing Switzerland

About this chapter

Cite this chapter

Buzzonetti, L., Valente, P., Petrocelli, G. (2017). Keratoconus in Children. In: Alió, J. (eds) Keratoconus. Essentials in Ophthalmology. Springer, Cham. https://doi.org/10.1007/978-3-319-43881-8_5

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-43881-8_5

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-43879-5

  • Online ISBN: 978-3-319-43881-8

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation