Corneal Cross-linking for Treatment of Progressive Keratoconus in Various Age Groups

Soeters, Nienke; Valk, Rikkert van der; Tahzib, Nayyirih G.

doi:10.3928/1081597x-20140527-03

Cited by 95 publications

(93 citation statements)

References 27 publications

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“…Furthermore, Chatzis and Hafezi [45] found that 88% of pediatric keratoconus patients progressed from initial visit. Soeters et al [54] reported keratoconic patients progressing 2.6 D in 7 weeks to 5.0 D over a year. The rapidity in which pediatric corneas evolve suggests that it may be inappropriate to wait for signs of progression as commonly done in adults to offer treatment, but in fact should be offered at diagnosis [1].…”

Section: Difference Between Adult and Pediatric Keratoconusmentioning

confidence: 99%

“…Adult patients who have undergone the procedure have less relapse [4], better functional and morphological results [55] and more sustainable effect over longer follow-up periods [56]. However, Soeters et al [54] did report more corneal flattening and more visual acuity improvement in children compared to adults after cross-linking, while Vinciguerra et al [57] reported better outcomes in adults ages 18–39. Vinciguerra et al [55] also reported that pediatric corneas had faster recovery of central corneal thickness compared to adults suggesting a faster healing process in young eyes.…”

Section: Difference Between Adult and Pediatric Keratoconusmentioning

confidence: 99%

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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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Section: Difference Between Adult and Pediatric Keratoconusmentioning

confidence: 99%

Section: Difference Between Adult and Pediatric Keratoconusmentioning

confidence: 99%

Pediatric keratoconus: a review of the literature

2017

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“…138 Meanwhile another study found that patients over 30 did better after cross-linking than other age groups. 149 …”

Section: Optimizing Cross-linking Successmentioning

confidence: 99%

Corneal cross-linking

Randleman

Khandelwal

Hafezi

2015

Survey of Ophthalmology

164

113

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Since its inception in the late 1990s, corneal cross-linking has grown from an interesting concept to a primary treatment for corneal ectatic disease worldwide. Using a combination of ultraviolet-A light and a chromophore (vitamin B2, riboflavin), the cornea can be stiffened, usually with a single application, and progressive thinning diseases such as keratoconus arrested. Despite being in clinical use for many years, some of the underlying processes, such as the role of oxygen and the optimal treatment times, are still being worked out. More than a treatment technique, corneal cross-links represent a physiological principle of connective tissue, which may explain the enormous versatility of the method. We highlight the history of corneal cross-linking, the scientific underpinnings of current techniques, evolving clinical treatment parameters, and the use of cross-linking in combination with refractive surgery and for the treatment of infectious keratitis.

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“…For example, age is associated with changes in visual acuity, as pediatric patients show better improvement than older patients in terms of corrected distance visual acuity (CDVA) following CXL [14, 15]. A Snellen CDVA value worse than 20/40 is also correlated with an improvement in visual acuity following CXL [16, 17].…”

Section: Introductionmentioning

confidence: 99%

Predictors for treatment outcomes after corneal crosslinking for keratoconus: a validation study

et al. 2016

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Previous research suggested that baseline corrected distance visual acuity (CDVA) and maximum keratometry (Kmax) are the predictors for effectiveness of corneal crosslinking (CXL) for keratoconus. The aim of this study was to validate the previously determined predictors in a new treatment cohort. A prospective cohort of 112 eyes in 90 consecutive patients was used to validate the results of 102 eyes in 79 patients from our previous prospective cohort. All patients were treated using epithelium-off corneal CXL in a tertiary hospital setting. Primary outcomes were changes in CDVA (LogMAR) and Kmax between baseline and 1-year post-treatment. Predictive factors for both outcomes were determined using univariable and multivariable analyses. Lower pretreatment CDVA was found to be the sole independent factor predicting an improvement in CDVA 1 year after CXL (β coefficient: −0.476, P < 0.01). Kmax flattening is more likely to take place in eyes with preoperative central cones (β coefficient: 0.655, P < 0.01). These results are consistent with our initial research and indicate high reproducibility in the new cohort. The previously postulated prediction model for postoperative CDVA showed limited predictive value in the validation cohort (R 2 = 0.15). The clinical implication of these results is that patients with lower pretreatment visual acuity are more likely to benefit from CXL (with respect to visual acuity), and patients with more central cones will benefit more in terms of cone flattening. Furthermore, those results can be used to guide customization of the crosslinking treatment.

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Corneal Cross-linking for Treatment of Progressive Keratoconus in Various Age Groups

Cited by 95 publications

References 27 publications

Pediatric keratoconus: a review of the literature

Pediatric keratoconus: a review of the literature

Corneal cross-linking

Predictors for treatment outcomes after corneal crosslinking for keratoconus: a validation study

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