José A P Gomes1, Donald Tan, Christopher J Rapuano, Michael W Belin, Renato Ambrósio, José L Guell, François Malecaze, Kohji Nishida, Virender S Sangwan. 1. *Department of Ophthalmology and Visual Sciences, Federal University of São Paulo/Escola Paulista de Medicina (UNIFESP/EPM), São Paulo, Brazil; †Cornea Service, Singapore National Eye Centre, Singapore, Singapore; ‡Cornea Service, Wills Eye Hospital, Philadelphia, PA; §Department of Ophthalmology and Vision Science, University of Arizona, Tucson, AZ; ¶Instituto de Olhos Renato Ambrósio, Rio de Janeiro, Brazil; ‖Department of Ophthalmology, Autonoma University of Barcelona, Barcelona, Spain; **Service d'Ophtalmologie, CHU Toulouse-Purpan, Toulouse, France; ††Department of Ophthalmology, Osaka University Medical School, Osaka, Japan; and ‡‡Center for Ocular Regeneration (CORE), L V Prasad Eye Institute, Hyderabad, India.
Abstract
BACKGROUND: Despite extensive knowledge regarding the diagnosis and management of keratoconus and ectatic corneal diseases, many controversies still exist. For that reason, there is a need for current guidelines for the diagnosis and management of these conditions. PURPOSE: This project aimed to reach consensus of ophthalmology experts from around the world regarding keratoconus and ectatic diseases, focusing on their definition, concepts, clinical management, and surgical treatments. METHODS: The Delphi method was followed with 3 questionnaire rounds and was complemented with a face-to-face meeting. Thirty-six panelists were involved and allocated to 1 of 3 panels: definition/diagnosis, nonsurgical management, or surgical treatment. The level of agreement considered for consensus was two thirds. RESULTS: Numerous agreements were generated in definitions, methods of diagnosing, and management of keratoconus and other ectatic diseases. Nonsurgical and surgical treatments for these conditions, including the use of corneal cross-linking and corneal transplantations, were presented in a stepwise approach. A flowchart describing a logical management sequence for keratoconus was created. CONCLUSIONS: This project resulted in definitions, statements, and recommendations for the diagnosis and management of keratoconus and other ectatic diseases. It also provides an insight into the current worldwide treatment of these conditions.
BACKGROUND: Despite extensive knowledge regarding the diagnosis and management of keratoconus and ectatic corneal diseases, many controversies still exist. For that reason, there is a need for current guidelines for the diagnosis and management of these conditions. PURPOSE: This project aimed to reach consensus of ophthalmology experts from around the world regarding keratoconus and ectatic diseases, focusing on their definition, concepts, clinical management, and surgical treatments. METHODS: The Delphi method was followed with 3 questionnaire rounds and was complemented with a face-to-face meeting. Thirty-six panelists were involved and allocated to 1 of 3 panels: definition/diagnosis, nonsurgical management, or surgical treatment. The level of agreement considered for consensus was two thirds. RESULTS: Numerous agreements were generated in definitions, methods of diagnosing, and management of keratoconus and other ectatic diseases. Nonsurgical and surgical treatments for these conditions, including the use of corneal cross-linking and corneal transplantations, were presented in a stepwise approach. A flowchart describing a logical management sequence for keratoconus was created. CONCLUSIONS: This project resulted in definitions, statements, and recommendations for the diagnosis and management of keratoconus and other ectatic diseases. It also provides an insight into the current worldwide treatment of these conditions.
Authors: Eric S Hwang; Claudia E Perez-Straziota; Sang Woo Kim; Marcony R Santhiago; J Bradley Randleman Journal: Ophthalmology Date: 2018-07-25 Impact factor: 12.079
Authors: Robert P L Wisse; Rob W P Simons; Martijn J B van der Vossen; Marc B Muijzer; Nienke Soeters; Rudy M M A Nuijts; Daniel A Godefrooij Journal: JAMA Ophthalmol Date: 2019-06-01 Impact factor: 7.389
Authors: Katja C Iselin; Emily Greenan; Colin Hynes; Sandra Shaw; Tim Fulcher; William J Power; Barry Quill; Marc Guerin; Weng H Lee; Conor C Murphy Journal: Ir J Med Sci Date: 2020-09-04 Impact factor: 1.568
Authors: Rafah Fairaq; Mohammed Almutlak; Enmar Almazyad; Abdulrahman H Badawi; Muhammad Ali Ahad Journal: Int Ophthalmol Date: 2021-03-27 Impact factor: 2.031