Psychiatric morbidity of patients with keratoconus: A cross-sectional study.

BACKGROUND: This study aimed to determine the prevalence of psychiatric disorders in patients with keratoconus and the effect of clinical parameters and psychiatric morbidity on quality of life in this patient group. MATERIALS AND METHODS: This cross-sectional study enrolled 94 patients with keratoconus. All patients underwent a complete ophthalmic and psychiatric examination and completed the The National Eye Institute Refractive Error Quality of Life Instrument-42 (NEI-RQL-42), Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI) questionnaires. The current diagnosis of psychiatric disorders was determined using the Structured Clinical Interview for DSM-IV (SCID). The impact of disease severity (binocular BCVA ≥0.4 logMAR, steep K reading ≥52, and Amsler-Krumeich grades) on vision-related quality of life was also analyzed. RESULTS: The patients' mean age was 23.9 ± 4.8 (range, 18-40) years. Of the 94 participants 35 (37.2%) had a psychiatric diagnosis, 13 (13.8%) had moderate-severe depression and 20 (21.2%) had moderate-severe anxiety according to the BDI and BAI, respectively. The probability of having a psychiatric disorder was higher if the keratoconus was more severe. Patients with a psychiatric diagnosis scored lower on physical functioning, role limitations due to emotional problems, energy/fatigue; emotional well-being, social functioning and pain subscales of the Short Form-36 (SF-36). Having a SCID-1 psychiatric diagnosis and the presence of a psychiatric disorder did not significantly affect NEI-RQL-42 questionnaire scores. CONCLUSIONS: There was high psychiatric morbidity among patients with keratoconus. Having a psychiatric disorder was associated with lower QoL as measured using the SF-36.

Efficacy of Conventional Versus Accelerated Corneal Cross-linking in Pediatric Keratoconus: Two-Year Outcomes.

PURPOSE: To compare the efficacy and safety of accelerated corneal cross-linking (CXL) with conventional CXL in pediatric patients with keratoconus. METHODS: Consecutive patients with keratoconus received either accelerated CXL (9 mW/cm2 irradiance for 10 minutes) or conventional CXL (3 mW/cm2 irradiance) for 30 minutes. Visual acuities (uncorrected [UDVA] and corrected [CDVA] distance visual acuity, logMAR), spherical error, cylindrical error, spherical equivalent, and keratometric values were recorded. Follow-up measurements were compared with baseline values. RESULTS: The study enrolled 48 eyes: 22 eyes had accelerated CXL (mean age: 16.0 ± 1.7 years) and 26 eyes had conventional CXL (mean age: 15.7 ± 1.6 years). Compared with preoperative values, all mean keratometric values significantly improved in the accelerated CXL group (flat [K1]: Δ = -0.64 D, P < .0001, steep [K2]: Δ = -0.63 D, P = .009 and Kmax: Δ = -0.55 D, P = .028), but no significant changes were observed in the mean UDVA and CDVA. In the conventional CXL group, all mean keratometric values and CDVA significantly improved (K1: Δ = -0.65 D, P = .017, K2: Δ = -0.87 D, P = .006, Kmax: Δ = -1.47 D, P = .011). No significant changes were observed in refractive error in either CXL group. There were no significant differences in the keratometric readings, visual acuities, or refractive error between the two groups at the 2-year follow-up. CONCLUSIONS: Both conventional and accelerated CXL protocols appear to be effective in stabilizing keratoconus progression in pediatric patients. Improved CDVA was also observed in the conventional CXL group. Accelerated CXL, with its advantage of shorter treatment duration, may be an alternative in pediatric patients. [J Refract Surg. 2020;36(4):265-269.].