Sequential Keraring implantation and corneal cross-linking for the treatment of keratoconus in children with vernal keratoconjunctivitis

Abstract

PurposeThe purpose of this study was to assess the safety and efficacy of femtosecond laser-assisted Keraring implantation followed by transepithelial accelerated corneal collagen cross-linking (CXL) for the treatment of keratoconus in children with vernal keratoconjunctivitis (VKC).Study designThis is a prospective interventional non-comparative case series.Patients and methodsEighteen eyes of 11 children with keratoconus and VKC were included in this study. All the cases were treated with femtosecond laser-assisted Keraring implantation followed after 2 weeks by transepithelial accelerated CXL, and the patients were followed up for 1 year.ResultsThe preoperative mean uncorrected visual acuity (UCVA) was 1.01±0.2 (logMAR), whereas the postoperative mean UCVA was 0.6±0.2. The preoperative mean best-corrected visual acuity (BCVA) was 0.6±0.1, whereas the postoperative mean BCVA was 0.40±0.2. The preoperative average keratometry was 50.3±2.7 D, whereas the postoperative average keratometry was 45.8±3.1 D.ConclusionThe results of this study suggest that femtosecond laser-assisted Keraring implantation followed by CXL is safe and effective in the management of keratoconus in children with VKC. However, studies with a longer follow-up period are needed.

Vernal Keratoconjunctivitis: A Systematic Review

“…36% of patients complained of a transient burning sensation during treatment Medium–low Chatterjee and Agrawal [ 114 ] 2016 India 23 14.7 To evaluate the efficacy of 0.03% tacrolimus ointment in the treatment of VKC Symptom and signs significantly reduced at 4 and 12 weeks ( p < 0.0001). Visual acuity showed an improvement after 12 weeks of treatment ( p = 0.05) High Yücel and Ulus [ 115 ] 2016 Turkey 30 12.9 To evaluate the efficacy and safety of topical cyclosporine A 0.05% in the treatment of VKC Topical CsA 0.05% (Restasis®) was effective in reducing VKC signs and symptoms ( p < 0.001) Medium–low Abozaid [ 116 ] 2017 Egypt 11 13.6 To assess the safety and efficacy of femtosecond laser-assisted Keraring implantation followed by transepithelial accelerated corneal collagen cross-linking (CXL) for the treatment of keratoconus in children with VKC All the eyes treated showed an improvement in visual acuity, keratometry values and refraction ( p < 0.001). No intraoperative complications were reported Medium Al-Amri et al [ 117 ] 2017 Saudi Arabia 20 16.9 To evaluate the safety and efficacy of 0.003% tacrolimus suspension for the treatment of refractory VKC 6 weeks of tacrolimus 0.003% therapy permitted a significant improvement in VKC symptoms ( p < 0.001) and signs ( p < 0.001), with no important side effects Medium–low Costa et al [ 118 ] 2017 Brazil 17 12.3 To evaluate the use of supratarsal injection of triamcinolone acetonide in severe VKC …”

“…In 2017, Abozaid [ 116 ] tried to assess the safety and efficacy of femtosecond laser-assisted Keraring implantation followed by transepithelial accelerated corneal collagen cross-linking (CXL) for the treatment of keratoconus in children with VKC. In their observational study, all the eyes treated showed an improvement in visual acuity, keratometry values, and refraction ( p < 0.001).…”

<p>Intrastromal Corneal Ring Segments Implantation And Corneal Cross-Linking For Keratoconus In Children With Vernal Keratoconjunctivitis – Three-Year Results</p>

“…In his prospective pilot study on children with keratoconus and VKC,13 Abozaid proved the safety and efficacy after one year of femtosecond laser-assisted keraring implantation followed by transepithelial cross linking. Unlike his study, this study was retrospective, had longer follow-up duration, had larger sample size, had a control group with CXL alone, and studied more parameters such as the corneal volume, Q value, and vector analysis of the astigmatism.…”

<p>Vector Analysis of Astigmatism in Keratoconic Eyes After Combined Intrastromal Corneal Ring Segments Implantation and Collagen Cross-Linking</p>

“…Keratoconus is a relatively common eye condition in upper Egypt where the climate is hot and dry. 1,2 It is a type of corneal ectasia characterized by thinning of the corneal stroma which assumes a conical shape resulting in progressive deterioration of vision secondary to induced myopia, astigmatism, and high order aberrations.…”