Tomographic and biomechanical refractive findings in ocular pediatric allergy

Abstract Purpose To investigate corneal tomographic and biomechanical refractive findings in ocular pediatric allergy to identify high-risk eyes for ectasia. Study Design A cross-sectional study Methods Fifty-seven patients (5–18 years), diagnosed with allergic conjunctival disease (ACD) between July 2022 and September 2023, underwent comprehensive ocular examinations and clinical assessments. The Ocular Allergy Severity Score (OCAS Score) was calculated to assess the severity of signs and symptoms. Tomographic-based and biomechanical parameters, including Corvis Biomechanical Index (CBI), Tomographic and Biomechanical Index (TBI), Belin/Ambrósio Deviation (BAD-D), and KISA% index, with a cut-off value of 0.5, 0.79, 2.6 and 100, respectively, were employed to identify corneal ectasia. Results Among 57 patients, 54.4% were diagnosed with vernal keratoconjunctivitis, 26.3% with seasonal allergic conjunctivitis, and 19.3% with atopic keratoconjunctivitis. The itching was the most common initial ocular symptom, followed by irritation and redness. The high-risk eyes for ectasia (based on CBI, TBI, BAD-D, and KISA%) were identified in 23.7%, 19.3%, 13.2%, and 7.9%, respectively. The ectatic group (determined by TBI) exhibited significantly higher mean curvature power (Km) (46.48±3.64 vs 43.10±1.31, p<0.001) and lower central corneal thickness (525.09±42.21 vs 561.20±30.91, p<0.001). However, there was no significant difference in the severity score of signs and symptoms between ectatic and non-ectatic groups. Isoametropic amblyopia was identified in 8.8% of patients, and anisometropic amblyopia was present in 1.8%. Conclusion In ocular pediatric allergy, the risk of developing corneal ectasia is unrelated to the severity of signs and symptoms. Therefore, routine tomographic and biomechanical evaluations are recommended.