Corneal collagen cross-linking in paediatric patients affected by keratoconus

Introduction/Objective The aim of this study was to report visual, refractive, and tomographic outcomes of corneal collagen cross-linking (CXL) in pediatric keratoconus. Methods This retrospective study included 17 eyes of 12 patients with progressive keratoconus who underwent epithelium-off CXL at the age ≤ 18 years. Following data were analyzed at baseline and postoperatively at one, three, six, nine, 12 months for all the patients, and annually where available: uncorrected distant visual acuity (UDVA) and best spectacle-corrected distant visual acuity (CDVA), refraction and corneal tomography. Results Mean UDVA improved significantly from 0.52 ± 0.38 at baseline to 0.24 ± 0.29 logarithm of minimum angle resolution (log MAR) at one year (p = 0.011) and remained stable at two-year follow-up (0.21 ± 0.34 log MAR). Mean CDVA was 0.15 ± 0.21 at baseline and 0.06 ± 0.13 log MAR at one year (p = 0.248). Maximum keratometry showed a significant flattening of 1.30 ± 1.99 D (p = 0.011) after a year and remained stable two years after CXL. Minimum keratometry significantly decreased with a mean change of 1.34 ± 1.37 (p = 0.001). Mean reduction of corneal thickness after CXL was 55.35 ± 64.42 µm (P=0.003). After a year, seven (42%) eyes showed Kmax regression, nine (53%) stabilization, and one (5%) progression. Conclusion In our study CXL effectively prevented progression of keratoconus in 95% of pediatric patients after a year, while improving UDVA and keratometry values. One patient with eye rubbing behavior showed signs of keratoconus progression after CXL treatment.

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“…Mild temporarily corneal haze was noticed in all patients. This was also described in similar studies [13,20].…”

Section: Discussionsupporting

confidence: 83%

Corneal collagen cross-linking in pediatric patients with keratoconus

et al. 2020

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“…As 5 studies did not report the 1-year follow-up outcomes of interest (Viswanathan et 1. Among these 26 trials, 17 were prospective studies [15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31], 7 were retrospective studies [32][33][34][35][36][37][38], and the designs of 2 studies were unclear [39,40]. A total of 1718 affected eyes were included in the systematic review.…”

Section: Characteristics Of the Included Trialsmentioning

confidence: 99%

Corneal Cross-Linking for Paediatric Keratoconus: A Systematic Review and Meta-Analysis

Kobashi

Hieda

Itoi

et al. 2021

JCM

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All corneal cross-linking techniques attenuated disease progression in patients with pediatric keratoconus for at least one year based on a meta-analysis. A standard and accelerated technique led to marked improvement in visual acuity. We determined the efficacy and safety of corneal cross-linking (CXL) in pediatric keratoconus by conducting a systematic review and meta-analysis. The PubMed and Cochrane databases were searched for relevant studies on the effects of standard, transepithelial, and/or accelerated CXL protocols in patients aged 18 years or younger. Standardized mean differences with 95% confidence intervals were calculated to compare the data collected at baseline and 12 months. The primary outcomes were maximum keratometry (Kmax) and uncorrected visual acuity (UCVA), and the secondary outcomes were the thinnest corneal thickness (TCT), best-corrected visual acuity (BCVA), and manifest refraction spherical equivalent or cylindrical refraction. Our search yielded 7913 publications, of which 26 were included in our systematic review and 21 were included in the meta-analysis. Standard CXL significantly improved the Kmax, UCVA, and BCVA, and significantly decreased the TCT. Accelerated CXL significantly improved UCVA and BCVA. In the transepithelial and accelerated-transepithelial CXL methods, each measurable parameter did not change after treatments. All CXL techniques attenuated disease progression in patients with pediatric keratoconus for at least one year. Standard and accelerated CXL led to marked improvement in visual acuity.

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“…[9][10][11] A number of retrospective observational studies of CXL in younger patients, with varying age ranges and duration of follow-up, have reported a beneficial effect of CXL. [12][13][14][15][16][17] Treatment of young patients by conventional ('Dresden') and accelerated CXL protocols have been reported to be similarly effective. 18 However more robust randomized evidence is required to inform practice, particularly in children and adolescents for whom there are few published studies.…”

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confidence: 99%

Effect of Corneal Cross-linking versus Standard Care on Keratoconus Progression in Young Patients

Larkin

Biswas²,

Bunce

et al. 2021

Ophthalmology

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Corneal collagen cross-linking in paediatric patients affected by keratoconus

Abstract: CXL is an effective treatment for avoiding keratoconus progression in paediatric patients. The procedure is safe and successful in stabilising keratoconus in eyes with more advanced forms of the disease, characterised by topographic K-max values greater than 60 D.

Cited by 23 publications

References 22 publications

Corneal collagen cross-linking in pediatric patients with keratoconus

Corneal collagen cross-linking in pediatric patients with keratoconus

Corneal Cross-Linking for Paediatric Keratoconus: A Systematic Review and Meta-Analysis

Effect of Corneal Cross-linking versus Standard Care on Keratoconus Progression in Young Patients

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