Collagen Crosslinking for Keratoconus Management in the Pediatric Population

Miller, Chase; Castro, Hannah Muniz; Ali, Shazia F

doi:10.1097/iio.0000000000000396

Cited by 4 publications

(4 citation statements)

References 70 publications

(230 reference statements)

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“…The typical onset of KC is puberty [ 3 , 4 ], with pediatric patients showing the highest rate and speed of progression [ 5 ]. In this light, prompt surgical intervention has been suggested in children and adolescents [ 6 , 7 ]. Corneal collagen cross-linking (CXL) has become the gold standard for mild and moderate stages to stop the progression of ectasia [ 6 , 8 ].…”

Section: Introductionmentioning

confidence: 99%

Topographic Outcomes in Keratoconus Surgery: Epi-on versus Epi-off Iontophoresis Corneal Collagen Cross-Linking

Napolitano

Tranfa

D’Andrea

et al. 2022

JCM

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Background: Corneal collagen cross-linking (CXL) has become the gold standard for mild and moderate stages to stop the progression of keratoconus. We analyzed some corneal topography indices to compare iontophoresis epi-on and iontophoresis epi-off techniques throughout a two-year follow-up. Methods: A total of 64 eyes of 49 patients who underwent CXL were recruited. In 30 eyes the epi-off technique was performed, whereas the remaining 34 eyes were treated with the epi-on technique. All patients underwent a complete ophthalmologic examination that included CDVA, central and thinnest corneal thickness, Schirmer test I, TBUT test, and the Ocular Surface Disease Index. Results: In both groups, a significant improvement in visual function was recorded. No statistically significant differences between Kmax, Mean K, Flat K, Steep K values were found. Statistically significant differences (p < 0.05) between the epi-on and epi-off groups’ pachymetry before and after 24 months follow-up as well as between the epi-on and epi-off groups’ topographically thinnest point in the immediate post-surgery and 24 months after surgery were recorded. Conclusion: Our study highlighted that both techniques are valid in mid-term corneal stabilization. The advantage of the new iontophoresis epi-off cross-linking technique could be found in a faster imbibing time of the cornea, therefore reducing surgical times, with a lower risk of complications.

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Section: Introductionmentioning

confidence: 99%

Topographic Outcomes in Keratoconus Surgery: Epi-on versus Epi-off Iontophoresis Corneal Collagen Cross-Linking

Napolitano

Tranfa

D’Andrea

et al. 2022

JCM

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“…In more advanced cases, scleral lenses might be more beneficial in neutralising the irregular cornea, and corneal surgery might be considered [ 4 ]. To prevent progression of the disease, a corneal crosslinking (CXL) procedure might be proposed for patients with sufficient corneal thickness (greater than 400 micrometres) [ 9 ].…”

Section: Introductionmentioning

confidence: 99%

“…From what is known, management of KC in the paediatric population can differ from the standard protocols described above, owing to the structural and behavioural differences between children and adults [ 3 ]. Moreover, disease progression in paediatric KC is far more aggressive than in adults [ 10 ] and therefore requires closer follow-up protocols and earlier consideration of interventions, such as CXL, that aim to halt progression [ 3 , 9 ].…”

Section: Introductionmentioning

confidence: 99%

Diagnosis and Management of Keratoconus—A Narrative Review of Clinicians’ Perspectives

et al. 2022

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This review discusses the current practices, attitudes, and trends in diagnosing and managing keratoconus (KC) in adults and children by optometrists and ophthalmologists in order to highlight the differences on a global scale. Two independent reviewers searched the electronic databases and grey literature for all potential articles published from 1 January 2000 to 1 June 2022 on management of KC. Keywords used in searches included “keratoconus”, “diagnosis”, “management”, “treatment”, “attitude”, “practices”, “opinion”, “optometrist”, “ophthalmologist”, “consensus”, and “protocol”. A total of 19 articles was included in this review—12 from the database search and seven from the grey literature. Although a common stepwise approach of non-surgical management was noted, there were differences in the rates of prescribing rigid gas permeable lenses. Furthermore, while clinicians agreed on the need for early diagnosis, the timeline and type of referral varied significantly. A similar discordance was found in the milestones for surgical intervention and preferred surgical techniques. Practice patterns in keratoconus diagnosis and management vary throughout the world. Multiple recommendations and suggestions to minimise the differences have been provided in the literature, with the main themes being improvement in education, interdisciplinary patient care, and further research to reach consensus.

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“…[6][7][8] CXL is nominated as gold standard for all ages for keratoconous. [9][10][11] Corneal collagen cross-linking was introduced in Bangladesh in 2011 in private hospitals. In 2019, it was also started in the Government hospital National Institute of Ophthalmology.…”

Section: Introductionmentioning

confidence: 99%

Visual improvement after corneal collagen cross-linking in keratoconus

Sultana¹,

Kadir²,

Hassan³

et al. 2022

IJCEO

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This study was carried out to evaluate the effect of corneal collagen cross-linking on visual acuity, astigmatism and topographic readings (K1, K2, Kapex). : A nonrandomized noncontrolled clinical study was conducted in two tertiary eye centres in Bangladesh from July 2017 to June 2019. All attending patients diagnosed with Keratoconus were included in this study according to selection criteria. Patients with a corneal thickness of fewer than 400 microns, previous viral infection, cornea scarring, corneal opacification, severe ocular surface disease, history of immune disorders, pregnancy, and breastfeeding were excluded from the study. All selected patients underwent collagen cross-linking with Riboflavin and Ultraviolet A, followed up five days, one and six months following the procedure. Visual acuity, topographic readings (K1, K2, Kapex) and cylindrical values were assessed on every visit. The mean value of visual acuity was compared statistically with the baseline value.: A total of 30 eyes of 30 patients were studied in this study. The male-to-female ratio was 2:1. The Mean age (± SD) of the study subjects was 22.7±7.10. Before CXL, the Mean uncorrected visual acuity (UCVA) ±SD was 0.86±.35. In post-CXL follow-up time, the mean UCVA±SD was 0.46±.23 after six months of CXL. Before CXL, the Mean BCVA±SD was 0.35±.22. In post CXL era, the Mean ± SD BCVA was 0.14±.13 after six months of CXL. The Mean K1±SD was 45.66±3.43 before CXL, and the result changed after CXL. The Mean K1±SD was 43.29±3.29 after six months of CXL. The Mean K2±SD was 50.22±5.93 before CXL, and the result differed after six months of CXL. The Mean Kapex ±SD was 54.50±7.38 before CXL, and that was 51.32±6.93 after six months of CXL. Keratoconus is a bilateral non-inflammatory disorder progressively leading to vision-threatening ocular morbidity. Collagen cross-linking improves visual and topographic findings– K1, K2, and Kapex and reduces astigmatism. Early diagnosis of Keratoconus and prompt treatment will help achieve better vision.

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Collagen Crosslinking for Keratoconus Management in the Pediatric Population

Cited by 4 publications

References 70 publications

Topographic Outcomes in Keratoconus Surgery: Epi-on versus Epi-off Iontophoresis Corneal Collagen Cross-Linking

Topographic Outcomes in Keratoconus Surgery: Epi-on versus Epi-off Iontophoresis Corneal Collagen Cross-Linking

Diagnosis and Management of Keratoconus—A Narrative Review of Clinicians’ Perspectives

Visual improvement after corneal collagen cross-linking in keratoconus

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