Pediatric Keratoconus: Clinical And Therapeutic Features

Keratoconus is a disease that most often appears in the second decade of life, generally progressing until the age of 40, and then stabilizing. In children, this pathology is rare and is associated with more severe and progressive forms than in adults. The aim of our study is to present the clinical, evolutionary and therapeutic particularities of pediatric keratoconus.

Pediatric keratoconus is more aggressive than adult keratoconus, and higher rates of progression have been reported. This is explained by the architectural differences of the cornea in the two populations. The treatment modalities used are the same as in adults. Nevertheless, progression and failure rates are higher in the paediatric population.

Retrospective study over a 3-year period (September 2020-September 2023) at the CHU Mohamed VI in Marrakech of patients under 18 years of age with keratoconus. Patients with advanced keratoconus at the surgical stage were excluded.

A total of 32 patients (60 eyes), mean age 13 years [8-18 years]. Eye rubbing was present in all patients, and associated allergic conjunctivitis was found in 27 patients, including 4 cases with vernal keratoconjunctivitis. Best corrected visual acuity was 5/10, and mean refractive astigmatism was 5.50D. Topographically, the cone was central in 46 eyes, mean maximum keratometry was 54 D, and mean central pachymetry was 410.56 µm. Therapeutically, 23 patients benefited from corneal cross-linking, and for optical correction, 10 patients were fitted with rigid gas-permeable lenses and the others with spectacles.

In children, keratoconus is often diagnosed at a more advanced stage than in adults. Screening and early diagnosis, through corneal topography, are essential in all children presenting with new-onset or recently progressive astigmatism. Close monitoring is also essential, so that appropriate treatment can be proposed.