Collagen cross-linking effect on progressive keratoconus in patients younger than 18 years of age: A clinical trial

Abstract

Background:Keratoconus is a bilateral non-inflammatory corneal disease. Collagen cross-linking (CXL) is a new treatment option for the disease that uses ultraviolet A light irradiation and riboflavin administration. The aim of this study is to evaluate the effect of CXL on corneal topographic and refractive values in patients with keratoconus younger than 18 years of age.Materials and Methods:For the clinical trial study, 37 patients (64 eyes) younger than 18 years of age with progressive keratoconus were included. Age, sex, family history of keratoconus, and history of allergic disorders and eye rubbing were recorded. Refractive, topographic, and topometric indices were evaluated before and 12 months after the CXL with 3mW for 30 minutes.Results:Mean age (±SD) of the patients was 15.83 ± 1.53 years; 26 (70.3%) of the 37 patients were male. Fourteen (37.8%) had positive family history of keratoconus, 11 (29.7%) had history of allergic disorders, and 15 (40.5%) had positive history of eye rubbing. Of the refractive values, cylinder value decreased significantly from −4.50 ± 0.29 to −4.11 ± 0.28 (P = 0.001). Also, the logarithm of minimal angle of resolution (logMAR) uncorrected visual acuity (UCVA) and best corrected visual acuity (BCVA) improved significantly 12 months after CXL (P = 0.012 and 0.001, respectively). Maximum keratometry before and after the operation was 53.82 ± 0.72 and 53.33 ± 0.72, respectively (P = 0.018). Differences for simulated K values, the thinnest cornea pachymetry, keratoconus index (KI), index of highest asymmetry (IHA), and index of highest decentration (IHD) before and 12 months after the CXL were statistically significant (P = 0.015, 0.034, <0.001, 0.017, 0.019, and 0.004, respectively).Conclusion:CXL improves the refractory, topographic, and topometric indices in patients with keratoconus younger than 18 years of age.

Two-year topographic and densitometric outcomes of accelerated (45 mW/cm2) transepithelial corneal cross-linking for keratoconus: a case-control study

“…CXL achieves its effect through increased formation of crosslinks in the corneal stroma, thus enhancing corneal biomechanical stiffness [28]. In severe KC, the cornea is generally thinner and less biomechanically stable [29] compared with mild KC.…”

Safety and efficacy of riboflavin-assisted collagen cross-linking of cornea in progressive keratoconus patients: A prospective study in North East India

“…Riboflavin-assisted corneal collagen cross-linking is considered one of the most promising treatments in PK nowadays. [1011152021222324252627] The present study reports visual and morphological outcome in 78 eyes over a period of 1 year in a prospective setting of riboflavin-assisted C3R treatment. The results of the current study demonstrate statistically significant improvement in UCVA, BCVA, CS, K min , Sim K, spherical and cylinder power, and SE in the treatment group.…”

“…Similar observations with spontaneous clearing of stromal haze by the 3 rd month were reported by various authors. [10182023333435] Caporossi et al . [14] concluded that patients with advanced stage of keratoconus are at an increased risk of corneal haze which develops after C3R, with the causes being low corneal thickness and high corneal curvature.…”

“…Using the K max values in the treated and untreated groups as 53.82 ± 0.72 D and 53.31 ± 0.72 D, respectively,[23]95% confidence interval (two sided), 80% power, and case-to-control ratio of 1:1, a sample size of 64 was calculated (32 in each group). Taking a 20% dropout, a sample size of 78 (39 in each group) was calculated.…”

Corneal Cross-Linking for Pediatric Keratoconus

“…[8][9][10] To date, however, no controlled trials have been performed to evaluate the efficacy or safety of CXL in children, although several cohort studies on crosslinking in pediatric populations have been published. [11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26] In this study, we provide a systematic overview of the published literature regarding the outcome in children with progressive keratoconus who underwent CXL. In addition, we report the long-term outcome (ie, up to 5 yrs after undergoing CXL) of our own pediatric patient population, focusing on the efficacy and safety of CXL.…”