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Kapur N, Chatterjee S, Gomase SN, Khurana A, Parmar G, Sangwan VS. Preferred practice patterns for keratoconus: An e-survey among Indian cornea specialists. Indian J Ophthalmol 2024; 72:111-117. [PMID: 38131580 PMCID: PMC10841772 DOI: 10.4103/ijo.ijo_817_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 07/31/2023] [Accepted: 08/02/2023] [Indexed: 12/23/2023] Open
Abstract
PURPOSE This study aimed to report practice patterns in the management of keratoconus in India. METHODS An e-survey was conducted among members of the Cornea Society of India to assess preferred practice patterns for keratoconus. RESULTS Of the 912 members, 234 (25.7%) completed the survey. About 88.4% worked in private eye care facilities and 76.1% in cities. Of all the respondents, 91.5% had access to a Scheimpflug-based device or an Orbscan II®; 71.4% of the respondents dispensed scleral contact lenses, and 66.7% dispensed Rose K contact lenses; 92.7% of the respondents performed corneal cross-linking (CXL); and 73.1% of the respondents performed deep anterior lamellar keratoplasty (DALK). A Scheimpflug device or Orbscan II®, Rose K or scleral contact lenses, and CXL were more readily available (P < 0.05) in private eye care facilities. The diagnostic criteria for keratoconus followed by the majority of the respondents (52.1%) were increase in corneal curvature, elevation, and thickness. An increase in keratometry values greater than 0.5 or 1.0D in a 6-month to 1-year period was considered the most favored criterion for keratoconus progression. Epithelium-off, 0.1% riboflavin solution in dextran, and accelerated protocol were the more commonly reported techniques in CXL. About 77.2% of the respondents routinely performed CXL in corneas <400 microns thick. Spectacles (91.0% of the respondents) and topography-guided photorefractive keratectomy (37.6% of the respondents) were, respectively, the preferred optical and surgical methods used to improve vision. CONCLUSION While keratoconus management in India is comparable to other developed healthcare systems, the concentration of trained corneal surgeons in cities and private eyecare facilities may lead to less equitable distribution of treatment across the country.
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Affiliation(s)
- Neha Kapur
- Department of Cornea and Anterior Segment, Dr Shroff’s Charity Eye Hospital, New Delhi, India
| | - Samrat Chatterjee
- Department of Cornea and Anterior Segment, MGM Eye Institute, Raipur, Chhattisgarh, India
| | - Sharad Nivrutti Gomase
- Department of Cornea and Anterior Segment, MGM Eye Institute, Raipur, Chhattisgarh, India
| | - Ashi Khurana
- Department of Cornea and Anterior Segment, CL Gupta Eye Institute, Moradabad, Uttar Pradesh, India
| | - Gautam Parmar
- Department of Cornea and Refractive Surgery, Sadguru Netra Chikitsalaya, Chitrakoot, Madhya Pradesh, India
| | - Virendra Singh Sangwan
- Department of Cornea and Anterior Segment, Dr Shroff’s Charity Eye Hospital, New Delhi, India
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Toprak I, Kilic D. Current clinical approach to pediatric keratoconus patients. EXPERT REVIEW OF OPHTHALMOLOGY 2022. [DOI: 10.1080/17469899.2022.2085557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Ibrahim Toprak
- Faculty of Medicine, Department of Ophthalmology, Pamukkale University, Denizli, Turkey
| | - Deniz Kilic
- Department of Ophthalmology, Kayseri City Training and Research Hospital, Health Science University, Kayseri, Turkey
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Management Outcomes in Pediatric Keratoconus: Childhood Keratoconus Study. J Ophthalmol 2022; 2022:4021288. [PMID: 35178249 PMCID: PMC8843789 DOI: 10.1155/2022/4021288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 12/19/2021] [Accepted: 01/08/2022] [Indexed: 11/17/2022] Open
Abstract
Introduction. The Global Delphi Panel of Keratoconus (KC) and Ectatic Diseases formulated management guidelines for KC in 2015. The aim of this study was to evaluate management outcomes in pediatric KC. Materials and Methods. Prospective, interventional study was conducted at a tertiary care hospital including KC patients aged <18 years. Based on disease severity and progression of disease, patients were prescribed either glasses or contact lenses (CLs) or underwent corneal collagen crosslinking (CXL), deep anterior lamellar keratoplasty (DALK), or penetrating keratoplasty (PK). Main Outcome Measures. Best corrected visual acuity (BCVA), manifest cylinder, maximum keratometry, thinnest corneal thickness, total higher order aberrations, and corneal hysteresis at baseline and 12 and 24 months. Results. 116 eyes of 62 patients with a mean age of 14.76 ± 2.77 years were included. 32.8% of the eyes (n = 38) achieved satisfactory BCVA with glasses/CLs only. Corneal collagen crosslinking (CXL) was performed in 43.1% of the eyes (n = 50) with progressive KC and halting of progression was noted in 83.3% (n = 35) of the eyes at 2 years. 7.7% of the eyes (n = 9) were managed for acute hydrops. DALK and PK were successfully performed in 9.5% (n = 11) and 6.9% (n = 8) of the eyes with BCVA of 0.14 ± 0.09 and 0.08 ± 0.12 at 2 years, respectively. Conclusions. Pediatric KC cases with progression show good visual and aberrometric outcomes and halting of progression after CXL. DALK and PK have good outcomes. The global consensus guidelines showed good clinical utility in pediatric patients. Presence of VKC did not have an impact on the outcomes of CXL in pediatric patients.
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Yang K, Gu Y, Xu L, Fan Q, Zhu M, Wang Q, Yin S, Zhang B, Pang C, Ren S. Distribution of pediatric keratoconus by different age and gender groups. Front Pediatr 2022; 10:937246. [PMID: 35923788 PMCID: PMC9339668 DOI: 10.3389/fped.2022.937246] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 06/30/2022] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To evaluate the distribution of pediatric keratoconus patients and the disease severity based on different age and gender groups in China. MATERIALS AND METHODS A total of 446 keratoconus eyes in 266 pediatric patients from January 2019 to January 2022 were included in the cross-sectional study. The clinical findings and severity of keratoconus were recorded and Kruskal-Wallis test, chi-squared test, and Cochran-Mantel-Haenszel (CMH) test were used to compare the parameters between different gender and age groups. RESULTS The male/female ratio was 353/93 (3.8:1), and the median age was 16 years (range: 6-17 years). Male patients were statistically younger than female patients (P = 0.041). The male/female ratio decreased with age (P for trend = 0.011). The distribution of the topographic keratoconus classification (TKC) stage was significantly different between gender and age groups (all P < 0.05). Male patients had a higher ratio of advanced keratoconus eyes (TKC ≥ 3) than female patients (P < 0.001), and CMH analysis indicated that being a male was a risk factor for advanced keratoconus after controlling for age (odds ratio: 2.581, P < 0.001). CONCLUSION Male keratoconus patients were younger, with a higher ratio of advanced keratoconus than female patients in the Chinese pediatric patients evaluated. Multicenter studies with larger sample sizes are necessary in the future.
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Affiliation(s)
- Kaili Yang
- Henan Provincial People's Hospital, Henan Eye Hospital, Henan Eye Institute, People's Hospital of Zhengzhou University, Henan University People's Hospital, Zhengzhou, China
| | - Yuwei Gu
- Henan Provincial People's Hospital, Henan Eye Hospital, Henan Eye Institute, People's Hospital of Zhengzhou University, Henan University People's Hospital, Zhengzhou, China
| | - Liyan Xu
- Henan Provincial People's Hospital, Henan Eye Hospital, Henan Eye Institute, People's Hospital of Zhengzhou University, Henan University People's Hospital, Zhengzhou, China
| | - Qi Fan
- Henan Provincial People's Hospital, Henan Eye Hospital, Henan Eye Institute, People's Hospital of Zhengzhou University, Henan University People's Hospital, Zhengzhou, China
| | - Meng Zhu
- Henan Provincial People's Hospital, Henan Eye Hospital, Henan Eye Institute, People's Hospital of Zhengzhou University, Henan University People's Hospital, Zhengzhou, China
| | - Qing Wang
- Henan Provincial People's Hospital, Henan Eye Hospital, Henan Eye Institute, People's Hospital of Zhengzhou University, Henan University People's Hospital, Zhengzhou, China
| | - Shanshan Yin
- Henan Provincial People's Hospital, Henan Eye Hospital, Henan Eye Institute, People's Hospital of Zhengzhou University, Henan University People's Hospital, Zhengzhou, China
| | - Bo Zhang
- Henan Provincial People's Hospital, Henan Eye Hospital, Henan Eye Institute, People's Hospital of Zhengzhou University, Henan University People's Hospital, Zhengzhou, China
| | - Chenjiu Pang
- Henan Provincial People's Hospital, Henan Eye Hospital, Henan Eye Institute, People's Hospital of Zhengzhou University, Henan University People's Hospital, Zhengzhou, China
| | - Shengwei Ren
- Henan Provincial People's Hospital, Henan Eye Hospital, Henan Eye Institute, People's Hospital of Zhengzhou University, Henan University People's Hospital, Zhengzhou, China
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