Abstract
PurposeTo report on the ability to perform corneal crosslinking (CXL) under local anaesthesia for the treatment of keratoconus in patients with Down syndrome.MethodsNine eyes of seven patients with both keratoconus and Down syndrome were scheduled for an epithelium-off CXL procedure under local anaesthesia. Exclusion criteria were a corneal thickness under 400 µm and the presence of corneal scars. A standardized clinical decision tool was used to estimate patient cooperation and the likelihood for a successful procedure under local rather than general anaesthesia.ResultsIn seven eyes, the CXL was completed successfully. The treatment was aborted in two eyes due to insufficient corneal thickness (<400 µm) prior to ultraviolet-A irradiation, even after employing hypoosmolar riboflavin. No adverse events occurred post-operatively, except for one case of delayed epithelial healing (23 days).ConclusionsWith a proper patient selection, CXL under local anaesthesia can be achieved in patients with Down syndrome.
Highlights
To report on the ability to perform corneal crosslinking (CXL) under local anaesthesia for the treatment of keratoconus in patients with Down syndrome
The study was a prospective case series of patients with Down syndrome and keratoconus scheduled for epithelium-off CXL under local anaesthesia at the University Medical Centre, Utrecht
This study reports the feasibility of a crosslinking procedure in patients with Down syndrome under local rather than general anaesthesia
Summary
Nine eyes of seven patients with both keratoconus and Down syndrome were scheduled for an epithelium-off CXL procedure under local anaesthesia. Corneal crosslinking (CXL) is a minimally invasive procedure that has the potential to slow keratoconus progression and prevent the development of keratoconus into stages where patients become dependent on rigid (scleral) contact lenses or corneal grafting procedures for an adequate visual acuity and quality of life [14, 15]. Patients with Down syndrome show higher risks during general anaesthesia (bradycardia, natural airway obstruction, difficult intubation, post-intubation croup, and bronchospasm); it is preferred to perform CXL under local anaesthesia [17–19]. We report on the potential to perform CXL procedures under local anaesthesia in patients with Down syndrome, our standardized clinical decision tool, and the outcomes of these treatments
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