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      Queratocono en edad pediátrica: características clínico-refractivas y evolución. Centro de Especialidades Médicas Fundación Donum, Cuenca, Ecuador, 2015-2018 Translated title: Keratoconus in pediatric age: clinical-refractive characteristics and evolution. Donum Foundation Medical Specialties Center. Cuenca. Ecuador. 2015-2018

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          Abstract

          Resumen Objetivo: Describir las características clínico-refractivas de pacientes con queratocono (KC) en edad pediátrica y su evolución, en el Centro de Especialidades Médicas Fundación Donum, Cuenca, Ecuador. Método: Se realizó un estudio observacional, prospectivo y longitudinal en 94 pacientes en edad pediátrica (188 ojos) con diagnóstico de KC, diagnosticados en 2015 y seguidos hasta 2018, en el Centro de Especialidades Médicas Fundación Donum, Cuenca, Ecuador. Se obtuvo la media aritmética de la muestra de: queratometría media, paquimetría en el punto más delgado y cilindro refractivo, en dos momentos. Se empleó el análisis de varianza (ANOVA) de medidas repetidas para un factor con ajuste del intervalo de confianza por Bonferroni y valor p. Resultados: Se obtuvo un aumento estadísticamente significativo entre el valor promedio de queratometría media de la muestra en el momento del diagnóstico (49.6 D) y el valor promedio de queratometría media a los 3 años de seguimiento (52.4 D) (p = 0.02; a = 0.05); una disminución estadísticamente significativa entre la paquimetría promedio de la muestra en el momento del diagnóstico (482 µm) y la paquimetría promedio de la muestra a los 3 años de seguimiento (459 µm) (p = 0.03; a = 0.05); y un incremento estadísticamente significativo entre el cilindro refractivo promedio de la muestra en el momento del diagnóstico (4.6 D) y el cilindro refractivo promedio de la muestra a los 3 años de seguimiento (5.1 D) (p = 0.01; a = 0.05). Conclusiones: Las modificaciones de queratometría, cilindro refractivo y paquimetría sugieren progresión de la enfermedad en este grupo de edad, en un periodo de 3 años.

          Translated abstract

          Abstract Objective: To describe the clinical-refractive characteristics of KC patients at pediatric age and their evolution, at the Donum Foundation Medical Center, Cuenca, Ecuador. Method: An observational, prospective and longitudinal study was carried out in 94 pediatric patients (188 eyes) diagnosed with KC, diagnosed in 2015 and followed up to 2018, in the Donum Foundation Medical Center, Cuenca, Ecuador. The arithmetic mean of the sample was obtained: mean keratometry, pachymetry at the thinnest point and refractive cylinder, at two moments. The analysis of variance (ANOVA) of repeated measures was used for a factor with confidence interval adjustment by Bonferroni and p value. Results: A statistically significant increase was obtained between the mean value of average keratometry of the sample (49.6 D), at the time of diagnosis, and the mean value of average keratometry at 3 years of follow-up (52.4 D). (p = 0.02; a = 0.05), a statistically significant decrease between the average pachymetry of the sample, at the time of diagnosis (482 µm), and the average pachymetry of the sample, at 3 years of follow-up (459 µm) (p = 0.03; a = 0.05) A statistically significant increase was obtained between the average refractive cylinder of the sample, at the time of diagnosis (4.6 D), and the average refractive cylinder of the sample, at 3 years of follow-up (5.1 D) (p = 0.01; a = 0.05). Conclusions: The modifications of keratometry, refractive cylinder and pachymetry suggest progression of the disease in this age group, in a period of 3 years.

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          Most cited references45

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          Keratoconus

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            Riboflavin/ultraviolet-a-induced collagen crosslinking for the treatment of keratoconus.

            In animal eyes, a significant increase in corneal biomechanical stiffness has been found after collagen crosslinking by combined riboflavin/ultraviolet-A (UVA) treatment. The aim of the present study was to evaluate the clinical usefulness of riboflavin/UVA-induced collagen crosslinking for bringing the progression of keratoconus to a halt. Prospective, nonrandomized clinical pilot study. Twenty-three eyes of 22 patients with moderate or advanced progressive keratoconus (maximum K value, 48-72 diopters) were included. After central corneal abrasion, photosensitizing riboflavin drops were applied and the eyes exposed to UVA (370 nm, 3 mW/cm(2)) in a 1-cm distance for 30 minutes. Postoperative examinations were performed in 6-month intervals, including visual acuity testing, corneal topography, slit-lamp examination, measurement of endothelial cell density, and photographic documentation. The follow-up time was between 3 months and 4 years. In all treated eyes, the progression of keratoconus was at least stopped. In 16 eyes (70%) regression with a reduction of the maximal keratometry readings by 2.01 diopters and of the refractive error by 1.14 diopters was found. Corneal and lens transparency, endothelial cell density, and intraocular pressure remained unchanged. Visual acuity improved slightly in 15 eyes (65%). Collagen crosslinking may be a new way for stopping the progression of keratectasia in patients with keratoconus. The need for penetrating keratoplasty might then be significantly reduced in keratoconus. Given the simplicity and minimal costs of the treatment, it might also be well-suited for developing countries. Long-term results are necessary to evaluate the duration of the stiffening effect and to exclude long term side-effects.
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              Keratoconus: an inflammatory disorder?

              Keratoconus has been classically defined as a progressive, non-inflammatory condition, which produces a thinning and steepening of the cornea. Its pathophysiological mechanisms have been investigated for a long time. Both genetic and environmental factors have been associated with the disease. Recent studies have shown a significant role of proteolytic enzymes, cytokines, and free radicals; therefore, although keratoconus does not meet all the classic criteria for an inflammatory disease, the lack of inflammation has been questioned. The majority of studies in the tears of patients with keratoconus have found increased levels of interleukin-6 (IL-6), tumor necrosis factor-α(TNF-α), and matrix metalloproteinase (MMP)-9. Eye rubbing, a proven risk factor for keratoconus, has been also shown recently to increase the tear levels of MMP-13, IL-6, and TNF-α. In the tear fluid of patients with ocular rosacea, IL-1α and MMP-9 have been reported to be significantly elevated, and cases of inferior corneal thinning, resembling keratoconus, have been reported. We performed a literature review of published biochemical changes in keratoconus that would support that this could be, at least in part, an inflammatory condition.
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                Author and article information

                Journal
                rmof
                Revista mexicana de oftalmología
                Rev. mex. oftalmol
                Sociedad Mexicana de Oftalmología A.C. (Ciudad de México, Ciudad de México, Mexico )
                0187-4519
                2604-1227
                October 2019
                : 93
                : 5
                : 221-232
                Affiliations
                [1] Cuenca Azuay orgnameUniversidad de Cuenca orgdiv1Facultad de Ciencias Médicas Ecuador
                Article
                S2604-12272019000500221 S2604-1227(19)09300500221
                10.24875/rmo.m19000082
                20bd3ab0-fdf9-4513-b504-3a50457c08d1

                This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

                History
                : 26 February 2019
                : 10 May 2019
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 46, Pages: 12
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                SciELO Mexico

                Categories
                Artículos originales

                Keratoconus,Cilindro refractivo,Agudeza visual,Keratometry,Pachymetry,Refractive cylinder,Visual acuity,Queratocono,Queratometría,Paquimetría

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