N. Mesplié

Scalability and Severity of Keratoconus in Children

PURPOSE To assess the severity of keratoconus at diagnosis and its scalability over a period of 2 years in children compared to adults. DESIGN A retrospective monocentric study was conducted in the National Reference Center for Keratoconus, Bordeaux (France), between October 1997 and November 2010. METHODS In total, 216 patients were studied, comprising 49 patients (22.7%) aged ≤ 15 and 167 patients (77.3%) aged ≥ 27 years at diagnosis, who were seen within 2 years of diagnosis. Severity at diagnosis was assessed using Krumeichs classification, and the scalability criteria of the US Food and Drug Administration (2010) were used. Student t tests and χ(2) tests were performed to compare the 2 groups. RESULTS Keratoconus in children was significantly more severe at diagnosis, with 27.8% being stage 4 vs 7.8% of adults (P < .0001). In addition, ophthalmoscopic signs were more frequent in children (42.9% vs 29.5%, P = .05), while mean values of maximum, average, and minimum keratometry as well as simulated keratometric astigmatism were higher (P < .0001, P = .0002, P = .0005, and P = .001, respectively). After diagnosis, keratoconus did not evolve more frequently in children. However, in the case of progression, keratoconus evolved faster in children, with significant differences in the spherical equivalent and maximum and minimum keratometry (P = .03, P = .02, P = .04, respectively). CONCLUSION At diagnosis, keratoconus is often more advanced in children than in adults, with faster disease progression. Early detection and close monitoring are therefore crucial in young patients.

Comparison of corneal thickness and biomechanical properties between North African and French patients.

Purpose To determine whether corneal thickness and rigidity vary between French and North African refractive surgery candidates. Setting Three clinics in North Africa and 1 hospital in France. Design Cross‐sectional study. Methods In part 1, the central corneal thickness (CCT) in North African patients and French patients having preoperative examinations was retrospectively compared. In part 2, the biomechanical properties of the corneas in the 2 groups were prospectively compared. Comparisons were performed using the Student t and chi‐square tests and multivariate linear and logistic regression. Results The retrospective study comprised 1662 patients from North Africa and 221 patients from France and the prospective study, 249 and 110, respectively. After adjustment for sex, age, and steepest keratometry, the mean CCT was statistically significantly thinner in North African patients (P<.0001). More than one fourth of North African patients had corneas thinner than 500 μm (28.9% versus 7.7% of French patients). Of patients with thin corneas, the mean corneal resistance factor (CRF) was statistically significantly lower in North African patients (P<.0001); there was no significant difference in corneal hysteresis. This remained true after adjustment for CCT (CCT‐adjusted difference in CRF between groups: −0.78; range −1.27 to −0.28; P=.002). Conclusion Corneas were thinner in North African patients than in French patients, and the CRF was different even when CCT was taken into accounted. More research is needed to determine whether these differences are associated with an additional risk for ectasia after laser in situ keratomileusis. Financial Disclosure No author has a financial or proprietary interest in any material or method mentioned.

Kératopathie centrale toxique et fibromyalgie : à propos d’un cas☆

INTRODUCTION A patient with fibromyalgia after laser refractive surgery presented bilateral diffuse lamellar keratitis complicated by central toxic keratopathy. CLINICAL CASE A 51-year-old patient, followed for fibromyalgia, consulted for visual loss 1 week after laser in situ keratomileusis. Slit lamp examination revealed stromal infiltrate in both eyes into the flap interface. Confocal microscopy showed an infiltration of inflammatory cells into the anterior stroma and the flap interface. Intensive topical corticosteroid treatment was used and the left eye was treated with flap lifting and interface irrigation. The corneal infiltrates decreased very slowly, and the left eye developed postoperative hyperopia. Diagnosis of central toxic keratopathy was discussed. Visual acuity, highly volatile, was limited to 7/10 (right eye) and 6/10 (left eye). CONCLUSION Diffuse lamellar keratitis (DLK) is a sterile inflammation after laser in situ keratomileusis. Central toxic keratopathy is characterized by noninflammatory central corneal opacification with a significant hyperopic shift. The cause of central toxic keratopathy is unknown. Fibromyalgia is a widespread, chronic pain disorder that includes a complex constellation of somatic and emotional symptoms. Patients often complain of dry eye sensations. Recent studies have highlighted a reduced corneal sensitivity in patients with fibromyalgia. There could be a relation between fibromyalgia, diffuse lamellar keratitis, and central toxic keratopathy. Some precautions may be used before LASIK in patients with fibromyalgia.