Pediatric Corneal Cross-linking: Comparison of Visual and Topographic Outcomes Between Conventional and Accelerated Treatment

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“…17 4 CHU9D: Child Health Utility 9D. 18 J o u r n a l P r e -p r o o f CHU9D utility score 0.9 (0.1) 0.9 (0.1) 0.9 (0.1)…”

Section: Discussionmentioning

confidence: 99%

“…[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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“…Keratoconus (KC) is a progressive, bilateral, thinning disorder of the cornea in which biomechanical changes in corneal collagen fibers result in progressive increase in corneal curvature and thinning 1,2. Occurring at an estimated (variable) prevalence in the general population of approximately 1:375 to 1:2,000, patients usually present with a deterioration in visual acuity secondary to myopia and irregular astigmatism.…”

Section: Introductionmentioning

confidence: 99%

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

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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“…Furthermore, Mazzotta et al also had a higher percentage of KC progression within a 10-year follow-up after standard CXL in 13 eyes (24% of the study eyes). 26 By contrast, Tian et al, 14 Sarac et al, 15 Baenninger et al, 16 and Badawi 27 report that no complications occurred in their studies of pediatric keratoconus treatments. Tian et al conclude that accelerated transepithelial CXL is a safe and effective procedure to treat progressive KC in pediatric patients.…”

Section: Discussionmentioning

confidence: 97%

“…[11][12][13] Other studies have also reported good results with CXL and ICRS implantation in pediatric KC. [14][15][16] To determine whether CXL-Plus could provide similarly good results in the treatment of pediatric KC, our study aimed to analyze the visual and refractive outcomes with respect to the stability and effectiveness of CXL combined with femtosecond laser ICRS implantation in pediatric KC.…”

Section: Introductionmentioning

confidence: 99%

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

Iqbal

Elmassry

Tawfik

et al. 2018

Current Eye Research

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Purpose: To analyze the visual and refractive outcomes of combined accelerated cross-linking with femtosecond laser intracorneal ring segment implantation for the treatment of pediatric keratoconus. Materials and Methods: This retrospective multicenter noncomparative clinical study included 63 eyes of 37 patients (age, 9-17 years) who underwent between August and September 2016 combined crosslinking with intracorneal ring segment implantation for keratoconus. Preoperative and postoperative (6, 12, and 18 months) uncorrected distance visual acuity (UDVA) and corrected distance visual acuity (CDVA), subjective refractions, keratometry (K), and pachymetry measurements were compared. Results: The postoperative spherical equivalent refraction was within ±1 D, ±2 D, and ±3 D in 19 (30.2%), 27 (42.9%), and 37 (58.8%) eyes, respectively. Only 27 eyes achieved the attempted preoperative spherical equivalent refraction. The mean spherical equivalent refraction significantly improved from −6.01 ± 2.97 to −3.13 ± 2.78 D postoperatively (P < 0.0001). The mean K average reading significantly decreased from 48.75 ± 4.25 to 46.65 ± 3.89 D postoperatively (P < 0.0001). The mean postoperative myopic, astigmatic, and spherical equivalent corrections were −2.17 ± 2.19, −1.52 ± 2.03, and −2.93 ± 2.35 D, respectively. The mean UDVA and CDVA showed significant improvements (0.89 ± 0.33 to 0.40 ± 0.28, P < 0.0001; 0.35 ± 0.31 to 0.25 ± 0.24, P = 0.004; respectively) at 18 months postoperatively. Keratoconus progression, segment migration, and segment extrusion were seen in four (6.4%), one (1.6%), and three (4.7%) eyes, respectively, probably contributing to the lower mean postoperative CDVA. Conclusion: Cross-linking plus is only partially effective for pediatric keratoconus. Despite some improvements in vision and keratometry measures, it resulted in complications such as keratoconus progression, segment extrusion, and segment migration that affected the vision in some patients. These findings suggest an assessment of standard epithelium-off collagen cross-linking as a sole procedure to treat pediatric keratoconus in future studies.

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Pediatric Corneal Cross-linking: Comparison of Visual and Topographic Outcomes Between Conventional and Accelerated Treatment

Cited by 28 publications

References 26 publications

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

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

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

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

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