Abstract
Introduction Keratoconus is a progressive corneal disease commonly treated by collagen cross-linking (CXL). Accelerated protocols have recently become common. This study sought to compare the outcomes of accelerated and standard CXL in terms of visual acuity, keratometry, and tomographic parameters in pediatric population. Methods We retrospectively reviewed the files of pediatric patients who underwent standard and accelerated CXL for keratoconus in our hospital, between October 2014 and March 2018. Changes in uncorrected distance visual acuity (UCDVA), best corrected distance visual acuity (BCDVA), tomographic keratometry parameters (Kmax, Ksteep, Kflat, Kmean), and endothelial density count (EDC) were assessed before and at 6 and 12 months following treatment. The analysis included intergroup and intragroup comparisons. Results This study included 53 eyes (44 patients). Fourteen eyes were treated with standard CXL (S-CXL, 3 mW/cm2, 30 min), while 39 underwent accelerated CXL (A-CXL, 9 mW/cm2, 10 min). Intergroup comparison found insignificant differences between groups, with the exception of better results for UCDVA in the S-CXL group after 12 months (P = 0.03). In this study, there was no significant difference between the two protocols postoperatively in BCDVA, Kmax, Kmean, pachymetry, or corneal astigmatism. Conclusion A-CXL is as safe and effective as S-CXL for stabilizing progressive keratoconus in pediatric population. Larger-sample-size studies with a longer follow-up time are required. Considering the long-term results of 9 mW A-CXL and its safety and efficacy profile, it should be preferred to S-CXL for reducing treatment time and improving patients' comfort.
Highlights
Keratoconus is a progressive corneal disease commonly treated by collagen cross-linking (CXL)
We retrospectively reviewed the files of pediatric patients who underwent S-CXL and A-CXL for keratoconus at the Department of Ophthalmology in Soroka University Medical Center, between October 2014 and March 2018. e diagnosis of keratoconus and its progression was made using a Pentacam tomographer (Pentacam, Oculus, Wetzlar, Germany). e preoperative progression was defined as a 1.5 D increase in the mean keratometric value or 1 D increase in Kmax or a decrease of 5% in central corneal thickness at two consecutive evaluations with Pentacam
Progression in Kmax was observed after 12 months in 7 (18.4%) eyes of the A-CXL group and in 1 (7.1%) eye of the standard CXL group (p .42, Figure 1)
Summary
Keratoconus is an ectatic disease of the cornea leading to visual impairment [1]. Classically, disease onset occurs at puberty. Koller et al showed in a prospective study on 105 eyes that S-CXL halted keratoconus progression after 12 months in 92.4%, and Poli et al in another prospective study showed stabilization of 89% at six years after treatment in patients with corneal ectasia [11, 12]. Mazzotta et al in a 10-year follow-up study that included 62 eyes of patients aged 18 and below found that S-CXL treatment stabilized the disease in nearly 80% and reduced the progression rate to 24% [13]. In the current retrospective study, we compared visual acuity, keratometry, and tomographic criteria between the S-CXL and A-CXL protocols in children with keratoconus at 6 and 12 months following the procedure, in order to determine if the A-CXL is as safe and efficient as the S-CXL. Patients underwent corneal tomography using Pentacam and EDC using Specular (noncontact specular microscopy) both preoperatively and at the 12-month follow-up
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