Keratoconus In Down Syndrome Patients: A Decade Of Retrospective Follow-Up Across Treatment Modalities
Published 2026 - 44th Congress of the ESCRS
Reference: PP05.06 | Type: Free paper | DOI: 10.82333/r0f5-8929
Authors: Dr Denise Wajnsztajn* 1 , Mrs Jenya Davelman 1 , Dr Hadas Mechoulam 1
1Ophthalmology,Hadassah Medical Center - Hebrew University Hospital,Jerusalem,Israel
Purpose
To analyze the outcomes of different treatment modalities — no intervention, corneal cross-linking (CXL), and penetrating keratoplasty (PKP) - in patients with Down syndrome (DS) diagnosed with keratoconus (KC).
Setting
Hadassah Medical Center - Ophthalmology Department.
Methods
A retrospective observational study was conducted at Hadassah – Hebrew University Medical Center, covering the period from January 2000 to January 2023. The sample included all patients with confirmed DS and documented KC, with available clinical data such as visual acuity, topography, and ocular examination. Exclusion criteria were missing topography data or other eye diseases affecting vision. Data collected included demographics, comorbidities, clinical findings, treatment type, and follow-up duration. The primary outcome measures were visual acuity (VA in LogMAR) and topographic outcomes (Kmax in Diopters) post-treatment; secondary outcomes included the natural history and progression in untreated eyes.
Results
We included 34 DS patients with KC (68 eyes), with a mean age of 27.8 years and a mean follow-up of 6 years. 42 eyes (63.2%) had no intervention, 20 eyes (29.4%) had CXL and 6 eyes (8.8%) had PKP. PKP patients were significantly older at presentation (33.5 ± 5.8 years) compared to CXL (21.9 ± 8.4) and no intervention (22.8 ± 9.1) (p = 0.02). No differences were found in gender or ethnicity among groups. Baseline Kmax (p = 0.41) and VA (p = 0.08) differences were not statistically significant. Changes in VA and Kmax between baseline and last follow up visit were not statistically significant between the 3 groups, although CXL eyes showed mean corneal steepening (+7.8D increase in Kmax) and decrease in vision (+0.12 increase in LogMAR).
Conclusions
Most KC eyes in DS patients remained relatively stable without intervention. CXL offers limited benefit in this population, while PKP can provide significant improvements in advanced cases. Early detection is critical but challenging, emphasizing the need for individualized treatment strategies tailored to patient abilities and needs.