Analysis of the Outcomes of Combined Cross-Linking with Intracorneal Ring Segment Implantation for the Treatment of Pediatric Keratoconus

Iqbal, Mohammed; Elmassry, Ahmed; Tawfik, Ahmed; Samra, Waleed Abou; Elgharieb, Mervat Elshabrawy; Elzembely, Hosam; Soliman, Ashraf; Saad, Hisham A; Saeed, Ahmed; Farouk, Mahmoud; Tawfik, Tarek; Ali, Amin Abou; Fawzy, Omar

doi:10.1080/02713683.2018.1540706

Cited by 17 publications

(17 citation statements)

References 26 publications

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“…The actual risk factors of KC progression after CXL are still not fully clear. The relationship between KC and VKC with eye rubbing has been previously postulated 31,39. Chronic eye rubbing leads to epithelial trauma with the release of metalloproteinase and cytokine enzymes.…”

Section: Discussionmentioning

confidence: 94%

Visual and Refractive Long-Term Outcomes Following Standard Cross-Linking in Progressive Keratoconus Management

Iqbal¹,

Elmassry²,

Badawi³

et al. 2019

OPTH

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PurposeTo analyze the effectiveness and stability of the refractive, topographic and visual outcomes of the standard cross-linking (SCXL) in keratoconus (KC) management.Patients and methodsThis study was designed as a retrospective non-comparative study that included 28 KC patients (n=49 eyes) who performed SCXL as a single procedure to treat KC and completed five-year follow-up period. The topographic, refractive and visual data were recorded preoperatively and at 12, 24, 36 and 60 months postoperatively.ResultsForty eyes (81.6%) showed achieved postoperative spherical equivalent (SE) refraction better than the attempted refraction. Ten eyes (20.4%) improved by <1 D, 23 eyes (46.9%) improved from 1 D to <2 D and 7 eyes (14.3%) improved by ≥2 D. Both uncorrected distant visual acuity (UDVA) and corrected distant visual acuity (CDVA) showed statistically significant improvement from preoperative 1.34±0.29 (mean±SD) and 0.74±0.23 LogMAR to postoperative 0.99±0.32 and 0.50±0.22 LogMAR (P<0.0001) respectively. Both Kmax and SE refraction showed statistically significant and stable improvement from preoperative 51.95±1.90 and −7.90±3.14 D to postoperative 50.19±1.96 and −6.35±2.49 D (P<0.0001) respectively. Two eyes (4%) showed KC progression at the end of 5th follow-up year.ConclusionSCXL had good effectiveness and stability that halted KC progression over 5-year follow-up period. It had also unexpected improvement in the KC refractive components mainly the spherical and SE components.

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Section: Discussionmentioning

confidence: 94%

Visual and Refractive Long-Term Outcomes Following Standard Cross-Linking in Progressive Keratoconus Management

Iqbal¹,

Elmassry²,

Badawi³

et al. 2019

OPTH

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“…; Mukhtar & Ambati ; Iqbal et al. ). At the end of our study, we documented progression of KC in 3 (25%) of 12 eyes with VKC after ACXL.…”

Section: Discussionmentioning

confidence: 99%

Standard cross‐linking protocol versus accelerated and transepithelial cross‐linking protocols for treatment of paediatric keratoconus: a 2‐year comparative study

Iqbal

Elmassry

Saad

et al. 2019

Acta Ophthalmologica

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Purpose: To compare the efficacy, safety and stability of standard epithelium-off cross-linking (SCXL) versus accelerated epithelium-off cross-linking (ACXL) and transepithelial epithelium-on cross-linking (TCXL) in the treatment of progressive keratoconus (KC) in children. Methods: This prospective multicentre controlled trial included 271 eyes (136 children) with grade 1-3 progressive KC who were randomized to undergo SCXL (n = 91, as a control group), ACXL (n = 92) or TCXL (n = 88). Uncorrected and corrected distance visual acuity, subjective refraction, pachymetry, keratometry and corneal topography measurements were recorded preoperatively and 6, 12 and 24 months postoperatively. Results: At 1 year, there was no significant difference in uncorrected distance visual acuity, refractive sphere, cylinder, spherical equivalent or Kmax between the ACXL and SCXL groups; however, during year 2, ACXL regressed while SCXL continued to improve. After 2 years, there were significant differences in all visual, refractive and keratometric components between SCXL and both ACXL and TCXL (p < 0.0001) and between ACXL and TCXL (p < 0.0001). KC progressed in 5.4% of patients who had ACXL and 28.4% of those who had TCXL but in none of those who had SCXL. Vernal keratoconjunctivitis was documented in 43.3% of eyes that progressed postoperatively. Conclusion: SCXL was more effective for paediatric KC and achieved greater stability than either ACXL or TCXL, and ACXL was superior to TCXL. SCXL also achieved marked improvement in both myopia and spherical equivalent; however, these refractive outcomes were unpredictable and uncontrollable. TCXL had a 28.4% failure rate within 2 years. SCXL is preferable for management of paediatric KC.

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“…Only a few retrospective interventional case series have been published regarding intracorneal ring segment (ICRS) implantation for the treatment of pediatric keratoconus, with varying results 39–42. The most recent study combined ICRS and crosslinking and examined visual, refractive, and keratometric outcomes in 12 patients aged 14 years or younger.…”

Section: Treatmentmentioning

confidence: 99%

Optimal management of pediatric keratoconus: challenges and solutions

Olivo-Payne¹,

Abdala-Figuerola²,

Hernández-Bogantes³

et al. 2019

OPTH

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Keratoconus (KC) shows several distinctive features in clinical appearance, disease progression, and treatment in children compared with adults. Therefore, diagnostic, clinical care, and therapeutic approaches are different. However, pediatric keratoconus is often undiagnosed and thus untreated in many cases. Once diagnosis has been made, compliance with treatment recommendations is often poor. Pediatric keratoconus also tends to have more rapid progression than in adults; therefore, early detection and treatment are paramount to prevent serious vision impairment, which can affect the child’s development. This review of pediatric keratoconus discusses important issues such as worldwide epidemiology, clinical features in children compared to adults, and challenges in diagnosis and treatment and focuses on the most appropriate management strategies based on the best available current evidence.

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Analysis of the Outcomes of Combined Cross-Linking with Intracorneal Ring Segment Implantation for the Treatment of Pediatric Keratoconus

Cited by 17 publications

References 26 publications

<p>Visual and Refractive Long-Term Outcomes Following Standard Cross-Linking in Progressive Keratoconus Management</p>

<p>Visual and Refractive Long-Term Outcomes Following Standard Cross-Linking in Progressive Keratoconus Management</p>

Standard cross‐linking protocol versus accelerated and transepithelial cross‐linking protocols for treatment of paediatric keratoconus: a 2‐year comparative study

<p>Optimal management of pediatric keratoconus: challenges and solutions</p>

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