Abstract
Aims: This study aimed to investigate the corneal biomechanical changes and topographic outcomes of accelerated transepithelial corneal cross-linking (ATE-CXL) in pediatric progressive keratoconus.Methods: In this prospective longitudinal study, 31 eyes of 28 pediatric patients with keratoconus (21 boys and 7 girls; mean age, 14.35 ± 2.68 years) undergoing ATE-CXL (epithelium-on procedure with 45 mW/cm2 for 320 s) were included. Corvis ST was used to measure dynamic corneal response parameters at baseline and at 12 month after ATE-CXL. Corneal keratometry and corneal thickness were measured using Pentacam pre-operatively and 1, 6, and 12 month post-operatively.Results: No serious complications occurred during or after ATE-CXL. The maximum keratometry values were 60.10 ± 7.51 D pre-operatively and 61.42 ± 8.92, 61.17 ± 7.96, and 60.02 ± 7.58 D at 1, 6, and 12 month after ATE-CXL (P > 0.05), respectively. Corneal thickness remained stable during the 12-month follow-up (P > 0.05). At post-operative 12 month, first applanation time (P < 0.001), first applanation length (P = 0.004), second applanation velocity (P = 0.014), highest concavity time (P = 0.022), and radius of curvature at highest concavity (P = 0.031) increased significantly. The value of stiffness parameter at first applanation was significantly increased from 57.70 ± 27.57 pre-operatively to 63.36 ± 27.09 at 12 months after ATE-CXL (P = 0.018).Conclusions: ATE-CXL is safe and effective in stabilizing the progression of pediatric keratoconus. Changes in corneal biomechanical response consistent with stiffening following ATE-CXL were observed in pediatric patients with keratoconus.
Highlights
Keratoconus is a bilateral progressive non-inflammatory ectatic corneal dystrophy characterized by thinning and steepening of the paracentral cornea [1], which usually appears during puberty, and early adulthood
This study aimed to investigate the corneal biomechanical changes and topographic outcomes of accelerated transepithelial corneal cross-linking (ATE-CXL) in pediatric progressive keratoconus
The majority of published studies [4,5,6,7] have demonstrated the safety and efficacy of CXL for pediatric keratoconus; most of these studies focused on conventional corneal cross-linking (CCXL; epithelium-off, 3 mW/cm2 for 30 min) in the corneas of pediatric patients
Summary
Keratoconus is a bilateral progressive non-inflammatory ectatic corneal dystrophy characterized by thinning and steepening of the paracentral cornea [1], which usually appears during puberty, and early adulthood. Keratoconus seems to progress faster and to be more advanced at the time of diagnosis in pediatric patients compared to adults [2]. Corneal cross-linking (CXL) is considered an effective treatment for halting or reducing the progression of keratoconus with increasing corneal biomechanical stiffness. The majority of published studies [4,5,6,7] have demonstrated the safety and efficacy of CXL for pediatric keratoconus; most of these studies focused on conventional corneal cross-linking (CCXL; epithelium-off, 3 mW/cm for 30 min) in the corneas of pediatric patients. We were the first to report [in a previous study [10, 11]] the long-term safety and efficacy of ATE-CXL for progressive pediatric keratoconus
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