<p>Comparative Results Between “Epi-Off” Conventional and Accelerated Corneal Collagen Crosslinking for Progressive Keratoconus in Pediatric Patients</p>

Abstract

PurposeThe aim of our study was to evaluate the efficacy and safety of epi-off conventional and accelerated corneal collagen cross-linking in the treatment of progressive keratoconus in pediatric patients up to 4 years after treatment.Patients and methodsConventional (standard) CXL epi-off technique was performed in 37 eyes (S-CXL group) and accelerated CXL in 27 eyes (A-CXL group). Refraction, keratometry, cylindrical equivalent, spherical equivalent, slit lamp examination, pachymetry, corneal tomography, anterior segment ocular coherence tomography and visual acuity were performed up to 4 years.ResultsIn the S-CXL group: the flat K values decreased from 47.41±3.39 D to 45.36±3.62 D at 4 years (p=0.004); steep K decreased from 51.98±4.11 to 50.21±4.81 D at 4 years (p=0.0078); mean K decreased with 1.99 D at 4 years (p=0.009). In the A-CXL group: the flat K values decreased from 46.97±4.17 D to 44.97±4.24 D at 4 years (p=0.048); steep K decreased from 50.55±4.10 D to 48.75±4.17 D at 4 years (p=0.0287); mean K decreased from 48.79±3.86 D to 46.86±4.11 D at 4 years (p=0.0356). The preoperative mean UCVA in the S-CXL group was 0.8 ±0.23 logMar and improved during the follow-up reaching 0.65 ±0.24 logMar at 4 years (p=0.072). The baseline mean UCVA in A-CXL group was 0.77±0.25 logMar and increased during the follow-up to 0.63 ±0.25 logMar at 4 years (p=0.0039). A similar improvement of BCVA was observed during the follow-up.ConclusionEpi-off conventional and accelerated CXL are efficient procedures for progressive keratoconus in pediatric patients. Accelerated and conventional CXL were comparable at all time points and both represent viable options for the therapy of KC in these patients.

WITHDRAWN: Comparison of Standard Versus Accelerated Epithelium-Off and Transepithelial Corneal Cross-Linking in Pediatric Keratoconus: An Up-to-date Meta-Analysis

“…Meta-analysis about the comparison of epithelium-off versus transepithelial CXL in adult or mixed-age (both adult and children) patients suggests SCXL and TCXL might provide a comparable effect on visual, refractive, pachymetric and endothelial outcomes post-surgery, 11 however in pediatric population such an analysis is still unavailable. Given the publications of new trials and comparative observations for CXL of different protocols in long-term follow-ups, [12][13][14][15][16] an update of summery is necessary. Hence, we conducted a meta-analysis to compare the e cacy of SCXL with ACXL, TCXL and A-TCXL in pediatric keratoconus.…”

The Comparison of Accelerated Corneal Crosslinking Treatment for Progressive Keratoconus in the Pediatric and Adult Age Groups: One-Year Results

“…Although a decrease was present in the mean CA values of the pediatric group patients at the 12th month compared to the preoperative period, the difference was not statistically signi cant (p: 0.345). Similarly, the difference between the postoperative 1st year CA values and the preoperative ones was not found to be signi cant for either procedure in the study by Nicula et al comparing S-CXL and A-CXL treatments [49]. However, postoperative 2nd year CA values were found to be signi cantly lower in the study of Padmanabhan et al where the S-CXL results in pediatric patients were investigated [44].…”

<p>Efficacy of Standard and Accelerated (10 Minutes) Corneal Crosslinking in Keratoconus Stabilization</p>

“…A study conducted by Nicula et al 11 concluded that after a 4-year follow-up, standard CXL reduced K1 from 47.41 D to 45.36 D (p = 0.004) and K2 from 51.98 D to 50.21 D (p = 0.0078), thus significantly contributing to the stabilization of keratoconus. In the Accelerated CXL protocol with 9 mW/cm 2 UVA irradiation for 10 minutes, there was also a reduction in K1 values, which decreased from 46.97 D to 44.96 D (p = 0.0048), and in K2 values, which decreased from 50.55 D to 48.75 D (p = 0.0287).…”

“…We included patients who had at least 0.75 D progressive steepening of the anterior corneal surface associated with progressive steepening of the posterior corneal surface, in two consecutive exams at least 6 months apart. 11,12 The exclusion criteria were patients with a corneal thickness of less than 450 microns, those previously treated (CXL or ring implant) and those who did not complete the minimum follow-up of 6 months. Keratometry measurements were obtained using a WaveLight Topolyzer topographic system.…”

“…8 Recent studies have concluded that the results of the standard and accelerated protocols are similar, including in children, although the results may vary considering irradiance, time and age, indicating the need for further studies to confirm the efficacy of the Accelerated protocol. 10,11 The objective of this study was to determine whether Accelerated CXL with UVA irradiation of 9 mW/ cm 2 for 10 minutes is as effective as standard CXL with UVA irradiation of 3 mW/cm 2 for 30 minutes in controlling the progression of keratoconus.…”