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  • Cornea/External Disease, Pediatric Ophth/Strabismus

    Review of: Natural history and predictors for progression in pediatric keratoconus

    Antunes-Foschini R, Doná H, Sant’Anna de Mello P, et al. Scientific Reports, March 2023

    Closer monitoring may be warranted for certain pediatric patients with keratoconus, according to this Brazilian study that found baseline steeper maximum keratometry (Kmax) and a history of allergies were independently associated with faster disease progression.

    Study design

    This was a retrospective cohort study in São Paolo, Brazil, evaluating 305 eyes from 168 pediatric patients with keratoconus aged 9 to 18 years. All included patients had no previous surgeries and a minimum of 36-month follow-up in a single academic clinic. Potential predictors of keratoconus progression, defined as a Kmax increase of 1.5 D on corneal tomography (Pentacam), included baseline tomographic parameters as well as age, sex, family history of keratoconus, and history of allergy.


    Approximately 40% of eyes progressed in a 12-month period; 50% progressed in a 20-month period. Steeper corneas (Kmax ≥ 55 D) at baseline and the presence of allergy were major factors associated with faster pediatric keratoconus progression. Interestingly, there was no difference in progression rates between patients younger than 14 years old and those aged 14 years or older.


    Limitations of this study include its retrospective design and exclusion of patients undergoing corneal crosslinking (CXL). In addition, there was a 12% loss due to lack of follow-up, a lack of inclusion of various Pentacam parameters (e.g., posterior elevation), and no mention of hand dominance. The authors’ definition of progression is also more conservative than the standard 1 D increase.

    Clinical significance

    Clinicians should monitor pediatric keratoconus patients closely, especially those with steeper corneas at baseline and presence of allergy as these may be indicators of faster disease progression. Since only 50% of individuals in the study progressed within 20 months, it may be reasonable to wait for keratoconus to show progression prior to performing CXL in pediatric patients to avoid some of the potential complications.

    Financial Disclosures: Dr. Neel Pasricha discloses financial relationships with Iota Biosciences and Vanda Pharmaceuticals (Consultant/Advisor).