Keratoconus in Children

Abstract

Keratoconus typically has its onset at puberty and progresses until the third to fourth decade of life, when it usually stabilizes. In pediatric patients keratoconus is often more advanced at diagnosis and its progression may be more frequent and more rapid with a sevenfold higher risk of requiring corneal grafting. Childhood onset cases have a more aggressive progression than those of later onset; therefore, detection of progressive keratoconus in early stages of the disease is necessary to prevent severe visual impairment. Keratoconus represents one of the most common causes of corneal transplantation in children causing about 15–20 % of all corneal transplants in children. The diagnosis of keratoconus in children is often made late. It depends on the scarcity of functional complaints in children, especially before the age of 8. Corneal cross-linking is actually the standard treatment for patients affected by keratoconus. In children as well as in adolescents it is actually indicated as soon as the diagnosis has been made without documented clinical progression because younger patients usually show a fast progression of keratoconus. Deep anterior lamellar keratoplasty appears the “best choice” in surgical treatment