Scalability and Severity of Keratoconus in Children

Léoni-Mesplié, S.; Mortemousque, B.; Touboul, David; Malet, Florence; Praud, Delphine; Mesplié, N.; Colin, Joseph

doi:10.1016/j.ajo.2012.01.025

Cited by 157 publications

(143 citation statements)

References 38 publications

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“…(3)(4)(5)(6)(7)12,(21)(22)(23)(24)(25)(26)(27) Considering that keratoconus generally begins in the second decade of life and has a progressive nature, pediatric patients may benefit from treatment with CXL. (28) Recent studies confirm the treatment's effectiveness, as well as the significant improvement of topographic features and visual acuity. [29][30] However, further monitoring suggests that despite initial improvement, pediatric patients may present long-term progression.…”

Section: Scientific Evidence Of Treatment Effectivenessmentioning

confidence: 77%

Corneal Crosslinking: The Standard Protocol

Santhiago¹

2017

Revista Brasileira De Oftalmologia

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RESUMOO objetivo desta revisão é de determinar as indicações e eficácia da cirurgia que promove novas ligações covalentes entre as fibras de colágeno da córnea, conhecida como Cross-Linking (CXL), assim como esclarecer seus objetivos. O ceratocone é uma doença ectasica da córnea, bilateral, assimétrica, que, principalmente, cursa com encurvamento e afinamentos progressivo, e se inicia em geral na segunda década de vida. O uso primário do CXL tem sido na interrupção da progressão do Ceratocone. Apesar do conhecido encurvamento no estroma da córnea ocorrer nesses pacientes, a fisiopatologia por trás do ceratocone ainda é desconhecida e parece ser multifatorial. Pela evidencia literária disponível até o momento, o CXL da córnea esta, portanto indicado nos pacientes com doença em progressão. Concluímos que existe evidencia suficiente para afirmar que o CXL da córnea é eficaz na estabilização da doença ectásica da cornea.Descritores: Córnea/fisiologia; Córnea/metabolismo; Cross-linking reagentes; Ceratocone/terapia; Riblflavina/administração & dosagem; Protocolos ABSTRACT The purpose of this review is to determine the indications and efficacy of the surgery that promotes new covalent bonds between the collagen fibers of the cornea, known as Cross-Linking (CXL), as well as to clarify its objectives. Keratoconus is a bilateral, asymmetric ectasic disease of the cornea that mainly courses with steepening and progressive thinning, and usually begins in the second decade of life.The primary use of CXL has been in discontinuing the progression of keratoconus. Although known corneal stromal remodeling occurs in these patients, the pathophysiology behind keratoconus is still unknown and appears to be multifactorial. By the literary evidence available to date, the CXL of the cornea is safely indicated in patients with progressing disease. We conclude that there is sufficient evidence to affirm that cornea CXL is effective in stabilizing corneal ectasic disease.

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Section: Scientific Evidence Of Treatment Effectivenessmentioning

confidence: 77%

Corneal Crosslinking: The Standard Protocol

Santhiago¹

2017

Revista Brasileira De Oftalmologia

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“…While the number of children and adolescents affected by keratoconus varies depending on the kind of clinical trial, two studies show that it ranges between 29 8 and 38% 9 of all treated keratoconus patients. This parasurgical treatment is safe and there is no visually significant risk, [10][11][12] although one study suggests that the halting of the disease might not be as long lasting as in adults. 12 It is worth pointing out, however, that we never had to repeat the treatment in our 10-year experience with CXL, even when dealing with pediatric keratoconus.…”

Section: Discussionmentioning

confidence: 99%

“…This parasurgical treatment is safe and there is no visually significant risk, [10][11][12] although one study suggests that the halting of the disease might not be as long lasting as in adults. 12 It is worth pointing out, however, that we never had to repeat the treatment in our 10-year experience with CXL, even when dealing with pediatric keratoconus. Pediatric keratoconus shows a higher incidence rate and a more rapid progression compared to adult keratoconus, 12 notwithstanding the fact that the disease is most frequently diagnosed after adolescence.…”

Section: Discussionmentioning

confidence: 99%

“…12 It is worth pointing out, however, that we never had to repeat the treatment in our 10-year experience with CXL, even when dealing with pediatric keratoconus. Pediatric keratoconus shows a higher incidence rate and a more rapid progression compared to adult keratoconus, 12 notwithstanding the fact that the disease is most frequently diagnosed after adolescence. The progressive visual impairment influences the social life as well as the educational development of affected children.…”

Section: Discussionmentioning

confidence: 99%

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Corneal Collagen Cross-linking in a Prepubescent 10-Year-Old Girl with Aggressive Keratoconus

Abbondanza¹,

Guidobaldi²

2015

International Journal of Keratoconus and Ectatic Corneal Diseases

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Keratoconus (KC) is a corneal ectatic disease that results in bilateral and asymmetrical corneal distortion, altered refractive powers and reduced vision. In 20 to 25% of cases, corneal transplantation may be required, although a number of conservative procedures are available. We report a case of an aggressive stage II keratoconus in a prepubescent 10-year-old girl, successfully treated with corneal collagen cross-linking (CXL) with epithelium removal.

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“…Было установлено более агрес-сивное течение болезни в детском возрасте, при ко-тором запущенные стадии кератоконуса выявлялись в 3 раза чаще, чем у взрослых [77]. Использование УФ-кросслинкинга у детей показало безопасность этой техники при ее высокой эффективности.…”

Section: возможности клинического применения уф-кросслинкингаunclassified

Ultraviolet Corneal Crosslinking

Бикбов¹,

Khalimov²,

Usubov³

2016

Annals RAMS

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Во всем мире ежегодно отмечается значительный рост заболеваний роговицы, сопровождающихся деструктив-ными изменениями коллагена в ее составе, что связывают с ухудшением экологии, интенсификацией глазной хи-рургии, травмами глаза, а также с увеличившимся числом офтальмоинфекций [1]. В Российской Федерации на больных с заболеваниями роговицы приходится до 18% общего числа слепых и слабовидящих [2].В основе кератоэктазий, в частности кератоконуса, лежит прогрессирующая деградация коллагеновой струк-туры роговицы и, соответственно, снижение ее прочност-но-механических свойств, приводящие к помутнению, нередко рубцеванию и значительному снижению остроты зрения. Как правило, это билатеральный патологический процесс, чаще наблюдаемый у лиц молодого трудоспо-собного возраста. Качественные и количественные из-менения состава коллагена органа зрения, отрицательно сказываясь на его структуре, проявляются в различных сочетаниях симптоматики болезни.Этиология кератоконуса считается многофакторной и наряду с вышеуказанными причинами включает также наследственную, эндокринную, аллергическую, имму-нологическую и другие теории, среди которых наиболее признанной у специалистов считается генетическая ги-потеза [3]. Несомненно, в пользу этого свидетельствуют семейные случаи заболевания, а также их сочетание с некоторыми наследственными синдромами. Так, по дан-ным мультицентрового проспективного исследования CLERK (США), генетические формы кератоконуса были выявлены в 13,5% случаев [4].В последнее десятилетие так называемый инжини-ринг тканей, базирующийся на процессах фотополи-меризации, стали использовать для лечения широкого спектра заболеваний. В частности, с целью укрепления роговой оболочки глаза при хронических дегенеративных процессах успешно применяется ультрафиолетовый (УФ) кросслинкинг роговицы (UV Corneal Crosslinking, CXL), основанный на ее облучении при длине волны 370 нм с использованием светочувствительного рибофлавина [5].Кросслинкинг (перекрестное связывание, или сши-вание) способствует стабилизации биомеханических свойств роговицы за счет увеличения количества свя-зей между фибриллами стромального коллагена, кера-тоцитами и белками межклеточной адгезии посредством рибофлавин-УФ-индуцируемых фотохимических реак-ций [5−8]

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Scalability and Severity of Keratoconus in Children

Cited by 157 publications

References 38 publications

Corneal Crosslinking: The Standard Protocol

Corneal Crosslinking: The Standard Protocol

Corneal Collagen Cross-linking in a Prepubescent 10-Year-Old Girl with Aggressive Keratoconus

Ultraviolet Corneal Crosslinking

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