الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
The cornea is the main refractive element of the eye; thus any pathology in its structure will have a detrimental effect on the overall quality of vision.
One such pathology is keratoconus. It is a bilateral progressive disorder of multi-factorial etiology. The estimated prevalence of keratoconus worldwide is 1/2000, with even higher estimates in the Middle East. It characteristically results in progressive myopia and irregular astigmatism.
It may be difficult to identify clinical signs early in the disease process, but recent imaging modalities have made this possible. Elevation-based imaging has become a cornerstone in diagnosis and management of keratoconus today.
Keratoconus management was previously focused on addressing the visual outcomes of the disease, but the attention has been shifted to target the pathogenesis of the disease in an attempt to halt its progression. This was made possible through the revolutionary concept of cross-linking.
Pediatric keratoconus is a disease entity that is under-diagnosed even sometimes overlooked. It tends to be diagnosed late, eventually resulting in considerable visual impairment that negatively impacts the child’s quality of life by affecting social and educational development. This disease tends to be more aggressive in the children than in adults, often resulting in the need of corneal transplantation.
Cross-linking has been extensively studied in the adult age group, but not as many studies are available targeting the pediatric age group. Thus, the aim of our study was to evaluate the corneal tomographic effects of cross-linking on pediatric keratoconus.
This retrospective, non-randomized, consecutive interventional study includes 30 eyes of 15 patients aging less than 18 years old with topographic findings consistent with keratoconus and a minimum corneal thickness of 400 micrometers that underwent cross-linking then had a minimum follow-up period of 1 year, after excluding those with history of herpetic keratitis and those with ocular and systemic diseases that delay wound healing.
Records were recovered from each of the patients’ visits starting from pre-operative, 3 months, 6 months, 1 year, and then each year thereafter. Fourteen topographic and pachymetric indices were collected from the full pentacam studies.
The studied group included 20 eyes (66.7%) belonging to males and 10 eyes (33.3%) belonging to females with a mean age of 13.33 ± 2.51. Statistically significant changes were detected during the follow-up in keratometric readings, Q, MAE, ISV, IVA, KI, and IHA. Significant changes in keratometric readings were mainly found at 3 months postoperative. Concerning Q, significant changes to less prolate values were observed between preoperative and 3-month postoperative visits (p=0.016), as well as between 12-month and 24-month postoperative visits (p=0.010).
As to the pachymetric data, statistically significant changes were detected during the follow-up in CCT and MCT. Specifically, a significant reduction in CCT and MCT was observed at 3 months after surgery (p<0.001), with no significant changes afterwards (p≥0.855). Concerning the X and Y coordinates of the position of the point of minimum thickness, no significant changes were detected during the follow-up