Corneal Collagen Cross-Linking for Keratoconus in Pediatric Patients—Long-Term Results

Padmanabhan, Prema; Reddi, Sudhir Rachapalle; Rajagopal, Rama; Natarajan, Radhika; Iyer, Geetha; Srinivasan, Bhaskar; Narayanan, Niveditha; Lakshmipathy, Meena; Agarwal, Shweta

doi:10.1097/ico.0000000000001102

Cited by 80 publications

(69 citation statements)

References 21 publications

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“…We also demonstrated continuous improvement in corneal topographic values with significant flattening of both Kmax and Kmin a year following CXL procedure; however, slight steepening was noticed after two years for available patients (eight eyes). This is in accordance with the results of previous studies with a follow-up duration ranging from one to three years [16]. Improvement in keratometric values was associated with significant decrease of ABFS suggesting global corneal flattening as well.…”

Section: Discussionsupporting

confidence: 92%

“…Although the main objective of CXL treatment is to prevent keratoconus progression, flattening of the cornea is commonly reported [7,15]. In ours, as well as in similar studies [8,16], initial steepening of both keratometric indices, Kmax and Kmin was observed during the first three months. This has been suggested to be the result of early epithelial remodeling [17].…”

Section: Discussionsupporting

confidence: 76%

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Corneal collagen cross-linking in pediatric patients with keratoconus

et al. 2020

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Introduction/Objective The aim of this study was to report visual, refractive, and tomographic outcomes of corneal collagen cross-linking (CXL) in pediatric keratoconus. Methods This retrospective study included 17 eyes of 12 patients with progressive keratoconus who underwent epithelium-off CXL at the age ≤ 18 years. Following data were analyzed at baseline and postoperatively at one, three, six, nine, 12 months for all the patients, and annually where available: uncorrected distant visual acuity (UDVA) and best spectacle-corrected distant visual acuity (CDVA), refraction and corneal tomography. Results Mean UDVA improved significantly from 0.52 ± 0.38 at baseline to 0.24 ± 0.29 logarithm of minimum angle resolution (log MAR) at one year (p = 0.011) and remained stable at two-year follow-up (0.21 ± 0.34 log MAR). Mean CDVA was 0.15 ± 0.21 at baseline and 0.06 ± 0.13 log MAR at one year (p = 0.248). Maximum keratometry showed a significant flattening of 1.30 ± 1.99 D (p = 0.011) after a year and remained stable two years after CXL. Minimum keratometry significantly decreased with a mean change of 1.34 ± 1.37 (p = 0.001). Mean reduction of corneal thickness after CXL was 55.35 ± 64.42 µm (P=0.003). After a year, seven (42%) eyes showed Kmax regression, nine (53%) stabilization, and one (5%) progression. Conclusion In our study CXL effectively prevented progression of keratoconus in 95% of pediatric patients after a year, while improving UDVA and keratometry values. One patient with eye rubbing behavior showed signs of keratoconus progression after CXL treatment.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionsupporting

confidence: 76%

Corneal collagen cross-linking in pediatric patients with keratoconus

et al. 2020

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“…Caporossi et al and Zotta et al [71, 72] reported stable efficacy at 3-year follow-up. More recent studies report stabilization in visual parameters at 4-year follow-up, including improvement in corrected distance vision (CDVA) in 69.1% of treated patients and a decrease in Kmax by 1.4 D ( p = 0.04) [69, 73, 74]. At 5-year follow-up, Godefrooji et al [75] showed improvement in maximum keratometry by mean of −2.06 diopters, p = 0.01.…”

Section: Results With Cross-linkingmentioning

confidence: 99%

Pediatric keratoconus: a review of the literature

2017

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Purpose To describe the epidemiology and prevalence, rates of progression, difference between adult and pediatric populations, and therapeutic approaches to pediatric keratoconus from documented literature. Methods A literature search was done on PubMed using key words including pediatric keratoconus, children with keratoconus, adult keratoconus, penetrating keratoplasty, corneal cross-linking and intra-corneal ring segments. The literature was reviewed and reported to explore the key epidemiological differences between the pediatric and adult population with regards to presentation and treatment options. Results Pediatric keratoconus is more aggressive than adult keratoconus, which has been explained by structural differences in the cornea between both populations. High rates of progression were documented in pediatric populations. While corneal collagen cross-linking, intracorneal ring segments and penetrating keratoplasties have been used as therapies in the pediatric population, the literature overwhelmingly shows higher rates of failure and progression despite these measures as compared to adults. Conclusion Pediatric keratoconus is more aggressive than adult keratoconus, and current therapies used in adults may not be sufficient for the pediatric population.

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“…[28][29][30] CXL has been proved in its effectiveness and safety in halting the progression of keratoconus and improving topographic and visual parameters in numerous prospective, published studies, including randomized controlled trials. [31][32][33][34][35][36] However, given the prolonged irradiation time of this standard CXL (SCXL) protocol, with total treatment times in excess of 1 hour, researchers have proposed accelerated CXL (ACXL) protocols, to improve convenience and comfort for patients. These ACXL protocols have the aim of decreasing UVA exposure time by increasing UVA fluency to achieve the same overall total UVA dosage.…”

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confidence: 99%