Corneal Tomographic, Aberrometric, And Endothelial Findings In Clinically Inactive Pediatric Ocular Rosacea: A Multimodal Imaging Study

Pediatric ocular rosacea (POR) is a chronic inflammatory disorder affecting the eyelids and ocular surface, characterized by a broad clinical spectrum ranging from meibomian gland dysfunction and blepharoconjunctivitis to keratoconjunctivitis and corneal neovascularization. The purpose of our study is to evaluate corneal tomographic, higher-order aberration (HOA), and endothelial characteristics in POR during the clinically inactive phase and compare them with age-matched controls.

This retrospective study was conducted at the Department of Ophthalmology, Kocaeli University, between January 2020 and January 2025.

This retrospective study included 40 eyes of 40 children (20 POR, 20 controls) examined during clinical inactivity (≥3 months after the last acute episode). All participants underwent Scheimpflug–Placido corneal tomography and non-contact specular microscopy. Keratometric, pachymetric, keratoconus screening indices, and HOAs over a 4-mm pupil were analyzed for anterior, posterior, and total corneal surfaces. Endothelial cell density (ECD), coefficient of variation (CV), and hexagonality were recorded.

SimK1, SimK2, Kmean, and CCT were similar between groups. Kmax was higher in POR (p=0.008), while keratoconus indices remained normal. Anterior corneal trefoil, spherical aberration, quadrafoil, and total HOA showed significantly greater magnitudes, whereas coma and Strehl ratio were comparable. Kmax was confined to eyes with corneal scarring/neovascularization, whereas anterior trefoil increased regardless of scarring/neovascularization. In multivariate analysis, anterior corneal trefoil remained independently associated with POR (p=0.013), whereas Kmax was not. ROC analysis demonstrated good discrimination for anterior corneal trefoil (AUC=0.855, 95%CI:0.733–0.977). ECD and CV were similar, but hexagonality was reduced (p=0.046).

Despite clinical inactivity, POR shows localized anterior steepening, asymmetric HOAs, and reduced endothelial hexagonality. Anterior corneal trefoil may serve as an adjunct parameter of inflammation-related micro-irregularity.