Global consensus on keratoconus and ectatic diseases.
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.


OBJECTIVE
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.
*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.
José A P
JA
Gomes
Donald
D
Tan
Christopher J
CJ
Rapuano
Michael W
MW
Belin
Renato
R
Ambrósio
José L
JL
Guell
François
F
Malecaze
Kohji
K
Nishida
Virender S
VS
Sangwan
D003315:Cornea / Q000473:pathology*; D003697:Delphi Technique; D004108:Dilatation, Pathologic / Q000175:diagnosis / Q000601:surgery; D014943:Global Health; D006801:Humans; D007640:Keratoconus / Q000175:diagnosis* / Q000601:surgery*; D011795:Surveys and Questionnaires; D009626:Terminology as Topic