Abstract
Aim To assess the efficacy and safety of accelerated corneal cross-linking in the treatment of pediatric keratoconus. Method In this retrospective case series, 29 eyes of 20 pediatric patients with keratoconus underwent accelerated corneal cross-linking. Treatment was delivered at 10 mW/cm2 for 9 minutes with a total dose of 5.4 J/cm2. Clinical evaluation included visual acuities and refractive and Scheimpflug corneal tomography assessments. All patients with a minimum follow-up duration of 24 months were included in the study. Results Mean ± standard deviation age was 15.41 ± 2.13 years (range: 8 to 18 years). Uncorrected distance visual acuity improved significantly from 0.56 ± 0.28 to 0.42 ± 0.29 logMAR (P=0.0003), and corrected distance visual acuity improved significantly from 0.34 ± 0.23 to 0.28 ± 0.22 logMAR (P=0.014). The mean manifest refraction spherical equivalent value was significantly reduced (−0.59 ± 0.95 D, P=0.0024). While mean flat keratometry and steep keratometry values were not significantly altered (P > 0.05 for both), the mean maximum keratometry value was significantly decreased from 56.97 ± 5.24 D preoperatively to 55.84 ± 5.37 D at 24 months postoperatively (P=0.003). Maximum keratometry had progressed by >1 D in two eyes (6.89%). Permanent corneal haze was reported in one case (3.44%). Conclusion Our 24-month follow-up demonstrated that accelerated corneal cross-linking appears to halt the progression of keratoconus in pediatric patients without apparent complications. Uncorrected and corrected distance visual acuities were also improved.
Highlights
Keratoconus (KC) is a progressive corneal disease characterized by thinning of the central or paracentral portion of the cornea resulting in irregular astigmatism and visual deterioration [1]. e onset of KC is usually around puberty, advanced cases have been reported in children as young as 4 years of age [2]
Ozgurhan et al reported their results of accelerated CXL in pediatric patients with KC where they found that uncorrected distance visual acuity (UDVA) and corrected distance visual acuity (CDVA) were significantly improved, 0.13 and 0.08 logMAR, respectively, at 24 months after CXL [24]
In our previously reported study [26] that compared an accelerated epithelium-off CXL with the standard Dresden protocol, we found that 6 eyes of 36 eyes treated with the standard CXL lost two or more lines of Snellen CDVA at the final follow-op. is was explained by the significant persistent haze formation in four eyes and scar development in two eyes
Summary
Clinical Outcomes of Accelerated Corneal Cross-Linking for Pediatric Keratoconus. Aim. To assess the efficacy and safety of accelerated corneal cross-linking in the treatment of pediatric keratoconus. In this retrospective case series, 29 eyes of 20 pediatric patients with keratoconus underwent accelerated corneal cross-linking. Clinical evaluation included visual acuities and refractive and Scheimpflug corneal tomography assessments. All patients with a minimum follow-up duration of 24 months were included in the study. E mean manifest refraction spherical equivalent value was significantly reduced (−0.59 ± 0.95 D, P 0.0024). Our 24-month follow-up demonstrated that accelerated corneal cross-linking appears to halt the progression of keratoconus in pediatric patients without apparent complications. Uncorrected and corrected distance visual acuities were improved
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