|Year : 2019 | Volume
| Issue : 4 | Page : 551-552
Pediatric keratoconus misdiagnosed as meridional amblyopia
Ritu Arora, Monica Lohchab
Department of Ophthalmology, Guru Nanak Eye Centre, Maulana Azad Medical College, New Delhi, India
|Date of Submission||22-Oct-2018|
|Date of Acceptance||05-Jan-2019|
|Date of Web Publication||22-Mar-2019|
B-448 Sector-1, Rohini, New Delhi - 110 085
Source of Support: None, Conflict of Interest: None
Keywords: Corneal collagen cross linking, meridional amblyopia, pediatric keratoconus
|How to cite this article:|
Arora R, Lohchab M. Pediatric keratoconus misdiagnosed as meridional amblyopia. Indian J Ophthalmol 2019;67:551-2
|How to cite this URL:|
Arora R, Lohchab M. Pediatric keratoconus misdiagnosed as meridional amblyopia. Indian J Ophthalmol [serial online] 2019 [cited 2019 Jul 18];67:551-2. Available from: http://www.ijo.in/text.asp?2019/67/4/551/254715
| Case Report|| |
A series of five children in the age group of 9–14 years were referred to our outpatient department from different primary centers with a diagnosis of anisometropic meridional amblyopia.
According to the past records [Table 1], corrected distance visual acuity (CDVA) with glasses in the affected eye ranged from 6/24–6/12 with myopic astigmatism of −2 to −3.5D. With a diagnosis of meridional amblyopia, occlusion of normal eye with patching was initiated. Contact lens trial or tomography was not done. Referral was done after a period of 6–8 months, as vision worsened despite the occlusion therapy.
|Table 1: Summary of data of five cases of pediatric keratoconus misdiagnosed as meridional amblyopia|
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At presentation to our center, progression from −3D to −5D (mean) of myopic astigmatism in 4 out of 5 (80%) patients, raised the suspicion of keratoconus [Table 1]. Two patients gave a history of allergic eye disease. Biomicroscopic signs (Vogt's striae and ectasia) were evident in two cases. Orbscan confirmed keratoconus [Figure 1] and [Figure 2] and CDVA improved to 6/6 with contact lens in all five children. A diagnosis of keratoconus without underlying amblyopia was made. Collagen cross linking followed by contact lens prescription was done for visual rehabilitation.
|Figure 1: Case 1: Orbscan quad map of a right eye forme fruste keratoconus (KC) (OD) and the left eye with KC (OS). The left eye was misdiagnosed with meridional amblyopia|
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|Figure 2: Case 2: Orbscan quad map of a normal right eye (OD) and the left eye with keratoconus (OS). The left eye was misdiagnosed with meridional amblyopia|
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| Discussion|| |
Despite the reported high incidence of pediatric keratoconus in South-East Asia,, it was misdiagnosed as amblyopia. Pediatric keratoconus is more likely to have rapid progression and may present at advanced stage with marked diminution of vision, even hydrops.,,
This report highlights the issue of difficult diagnosis and rapidly progressive nature of pediatric keratoconus. Corneal tomography is recommended in children with myopic astigmatism and steep keratometry. Eye rubbing should be discouraged with proper management of allergic eye disease. Early diagnosis is crucial in this subgroup of patients to arrest the progression by early collagen cross linking.
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Conflicts of interest
There are no conflicts of interest.
| References|| |
Georgiou T, Funnell CL, Cassels-Brown A, O'Connor R. Influence of ethnic origin on the incidence of keratoconus and associated atopic diseases in Asian and white patients. Eye (Lond) 2004;18:379-83.
Saini JS, Saroha V, Singh P, Sukhija JS, Jain AK. Keratoconus in Asian eyes at a tertiary eye care facility. Clin Exp Optom 2004;87:97-101.
Léoni-Mesplié S, Mortemousque B, Touboul D, Malet F, Praud D, Mesplié N, et al
. Scalability and severity of keratoconus in children. Am J Ophthalmol 2012;154:56-62.e1.
McMahon TT, Edrington TB, Szczotka-Flynn L, Olafsson HE, Davis LJ, Schechtman KB, et al
. Longitudinal changes in corneal curvature in keratoconus. Cornea 2006;25:296-305.
Jonas JB, Nangia V, Matin A, Kulkarni M, Bhojwani K. Prevalence and associations of keratoconus in rural Maharashtra in central India: The central India Eye Medical Study. Am J Ophthalmol 2009;148:760-5.
[Figure 1], [Figure 2]