Current approaches to the diagnosis and treatment of keratoconus in children: a review

Keratoconus is a progressive degenerative corneal condition, characterized by disrupted and disorganized structure of the collagen matrix, which leads to corneal thinning and ectasia. The combined impact of genetic, hormonal, and environmental factors underlie the pathogenesis. The peak manifestation of the condition is usually observed in adolescence and at a young age (15–30 years). However, there are cases of earlier onset, including at a preschool age (the authors had a case in a 5-year-old child), which highlights the need for early detection and timely treatment to prevent irreversible vision loss. Given specific features of children, early diagnosis and timely treatment are critical for preventing severe complications and subsequent need for keratoplasty.

The article reviews current data on the clinical presentation, diagnostic approaches, and treatment strategies for pediatric keratoconus, with a focus on corneal cross-linking as the most effective way to stabilize the condition. The article also discusses the standard Dresden protocol and its modifications, including transepithelial, partial, and accelerated cross-linking, and methods used in case of the thinned cornea.