Pediatric Crosslinking: Current Protocols and Approach

Abstract

Keratoconus (KC) is likely to be more aggressive in the pediatric population, with a higher risk of progression and visual loss. Several techniques have been proposed for corneal crosslinking (CXL) so far. The standard CXL (SCXL) technique, or the Dresden Protocol, originally developed by Wollensak et al., has been shown to be safe and effective in the pediatric KC group. With similar efficacy to the conventional method, the accelerated CXL (ACXL) protocols proposed a reduced UVA exposure time by increasing the intensity of UVA irradiation. Transepithelial CXL (TCXL), considered an “epithelium-on” method, emerged as a strategy to improve safety and reduce postoperative complications and discomfort. For thinner corneas, we can highlight the use of hypoosmolar riboflavin and new studies, such as contact lens-assisted CXL (CACXL), the epithelial-island CXL (EI-CXL), and the Sub400 protocol. In addition to the different protocols used, another factor that changes CXL results is the type of carrier used: dextran-based or hydroxypropyl methylcellulose-based (HPMC) riboflavin solutions. There are several ways to perform a CXL surgery, and it is still unclear which method is the safest and most effective in the pediatric group. This review of the literature in English, available in PubMed, provides an update on corneal CXL in the pediatric KC group, exploring the data on the techniques currently used and under investigation, including their advantages, efficacy, safety profiles, risks, and cost analyses.

Actualización de las conductas a seguir en el tratamiento del queratocono

“…La mayor parte de la literatura describe la enfermedad durante la pubertad, pero un reporte del caso más reciente documentó un caso a los 4 años. (6)…”

“…Estudios recientes realizados desde 2009 en Oriente Medio y Asia estimaron la prevalencia de queratocono de 0,9 a 3,3 %. (6,7) Se ha documentado previamente que un proceso no inflamatorio está involucrado en la patogenia de la enfermedad; sin embargo, estudios recientes han encontrado marcadores inflamatorios y citocinas, incluidas interleucinas (IL-1, IL-6, IL-8), TNF-α, en las lágrimas de pacientes con queratocono. Se encuentra un desequilibrio entre las citoquinas proinflamatorias y las citoquinas antiinflamatorias lo que esto conlleva a un cambio en la estructura y función de la córnea.…”