Risk Factors for Keratoconus Progression in Children Compared with Young and Middle-aged Adults

Abstract

Background To investigate the risk factors for keratoconus progression in children (10 – 18 years old; age group 1) compared to young adults (19 – 35 years old; age group 2) and middle-aged adults (36 – 55 years old; age group 3).

Patients/Methods Ninety-seven children, 445 young adults, and 342 middle-aged adults underwent total ophthalmic examination including clinical refraction, slit lamp examination, corneal tomography, eye biometry, and biomechanical properties measurements. Comparisons were assessed among three age groups and between progressive and nonprogressive eyes. Logistic regression was applied to determine the potential prognostic factors for keratoconus progression in the three age groups.

Results Univariate logistic regression analysis show that the most prominent factors associated with progression were corneal posterior vertical radius (RVP), eye rubbing (RUB), slit lamp corneal thinning (SLT), contact lens use (CL), and central corneal thickness (CCT) in all age groups. Additionally, the anterior chamber volume (ACV) and keratoconus match index (KMI) were associated with progression in age group 1. Location of the thinnest corneal thickness at the vertical axis (TCTy), distance from apex to the thinnest point (BADISTAPEX), scissor reflection in retinoscopy (SKIAREFLEX), and Vogt striae were associated with progression in age group 2, and TCTy, anterior and posterior asphericity (ASPA and ASPP, respectively), BADISTAPEX, SKIAREFLEX, and Vogt striae were associated with progression in age group 3. The multivariate model with the highest predictability indicated RVP, ACV, and SLT as independent determinants of progression in age group 1 (AUC: 90%, sensitivity: 88.9%, specificity: 90.9%), RVP, ACV, SLT, and SKIAREFLEX in group 2 (AUC: 81.6%, sensitivity 88.5%, specificity: 70.3%), and RVP, SLT, Vogt striae, and CL in age group 3 (AUC: 80%, sensitivity 82.8%, specificity: 73%).

Conclusion ACV and KMI seem to play a major role in the progression of pediatric KC compared to adults. This is probably due to different anatomical and biomechanical characteristics of a childʼs eye globe.

Zusammenfassung

Hintergrund Diese Studie untersucht die Risikofaktoren für das Fortschreiten des Keratokonus bei Kindern (10 – 18 Jahre) im Vergleich zu jungen Erwachsenen (19 – 35 Jahre) und Erwachsenen mittleren Alters (36 – 55 Jahre).

Patienten und Methoden 97 Kinder, 445 junge Erwachsene und 342 Erwachsene mittleren Alters unterzogen sich einer umfassenden augenärztlichen Untersuchung, die eine klinische Refraktion, eine Spaltlampenuntersuchung, eine Hornhauttomografie, eine Augenbiometrie und eine Messung der biomechanischen Eigenschaften umfasste. Es wurde ein Vergleich zwischen den 3 Altersgruppen sowie zwischen progressiven und nicht progressiven Augen vorgenommen. Mithilfe einer logistischen Regression wurden die potenziellen prognostischen Faktoren für das Fortschreiten des Keratokonus in den 3 Altersgruppen verglichen.

Ergebnisse Eine univariate logistische Regressionsanalyse zeigt, dass die folgenden wichtigsten Faktoren mit dem Fortschreiten des Keratokonus in allen Altersgruppen assoziiert sind: vertikaler Krümmungsradius der hinteren Hornhaut (RVP), Augenreiben (RUB), Spaltlampen-Hornhautausdünnung (SLT), Tragen von Kontaktlinsen (CL) und zentrale Hornhautdicke (CCT). Zusätzlich wurden das Vorderkammervolumen (ACV) und der Keratokonus-Match-Index (KMI) mit der Progression in der Altersgruppe 1 in Verbindung gebracht. Die Stelle der dünnsten Hornhautdicke an der vertikalen Achse (TCTy), der Abstand vom Apex zur dünnsten Stelle (BADISTAPEX), die helle Reflexion des nasalen Bereichs des Limbus (SKIAREFLEX) und die Vogt-Linien wurden mit der Progression in der Altersgruppe 2 assoziiert, und TCTy, vordere und hintere Asphärizität (ASPA bzw. ASPP), BADISTAPEX, SKIAREFLEX und Vogt-Linien wurden mit der Progression in der Altersgruppe 3 assoziiert. Das Multivarianzmodell mit der höchsten Vorhersagbarkeit zeigte RVP, ACV und SLT als unabhängige Determinanten der Progression in Altersgruppe 1 (AUC: 90%, Sensitivität: 88,9%, Spezifität: 90,9%), RVP, ACV, SLT und SKIAREFLEX in Gruppe 2 (AUC: 81,6%, Sensitivität 88,5%, Spezifität: 70,3%) und RVP, SLT, Vogt-Linien und CL in Altersgruppe 3 (AUC: 80%, Sensitivität 82,8%, Spezifität: 73%).

Schlussfolgerungen Das Volumen der Vorderkammer und der Keratokonus-Match-Index scheinen beim Fortschreiten des KC bei Kindern im Vergleich zu Erwachsenen eine größere Rolle zu spielen. Dies ist wahrscheinlich auf die unterschiedlichen anatomischen und biomechanischen Merkmale des kindlichen Augapfels zurückzuführen.

Key words

keratoconus - progression - adults - risk factors - pediatric

Schlüsselwörter

Keratokonus - Progression - Risikofaktoren - Pädiatrie - Erwachsene

Publication History

Received: 01 December 2022

Accepted: 30 January 2023

Accepted Manuscript online:
31 January 2023

Article published online:
22 June 2023

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