Abstract
Purpose To evaluate corneal transparency following accelerated collagen cross-linking (ACXL) in pediatric keratoconus. Design A prospective interventional case series. Methods This study included 47 eyes (25 patients), aged 9–14 years, with documented progressive keratoconus. After applying 0.1% riboflavin drops, ACXL was performed. Assessment included corrected distance visual acuity (CDVA), uncorrected visual acuity (UCVA), corneal haze, and corneal densitometry in grayscale units (GSU). Result The mean baseline and corneal densitometry peaked at 3 months post-ACXL while central and posterior densitometry showed a statistically significant increase (P < 0.05) and peaked at 8 months postoperatively. By 12 months, densitometry in all corneal layers (P ≥ 0.99) and concentric zones (P ≥ 0.97) reached near baseline values. Slit-lamp graded haze peaked at 1 month to 1.82 ± 0.65 (P < 0.05) and declined to near baseline at 12 months (0.39 ± 0.58). There was a statistically significant increase in the mean UCVA and CDVA at 12 months. Conclusion Total and anterior corneal densitometry peaked after 3 months, while central and posterior densitometry peaked after 8 months. Maximum haze was at 1 month post-ACXL. All corneal layers, concentric zone densitometry and haze reached near baseline values after 1 year. Scheimpflug densitometry showed weak correlation with CDVA over the 12-month follow-up period (r = −0.193).
Highlights
Visual rehabilitation after CXL, especially in children, may be prolonged up to 12 months postoperatively, with variable courses and predisposing factors [1].Wollensak et al first introduced CXL for the treatment of progressive keratoconus in 2003
We clinically evaluated corneal transparency as a primary variable following ACXL
The Scheimpflug corneal densitometry in the anterior, middle, and posterior stromal layers had increased during the postoperative period (Table 1)
Summary
Wollensak et al first introduced CXL for the treatment of progressive keratoconus in 2003. It aims at halting the progression of keratoconus and deferring the need for keratoplasty [2]. Standard CXL with 30 minutes of exposure to UV irradiation of 3 mW/cm as described in the Dresden protocol proved to increase its biomechanical strength in the anterior 200 μm of the corneal stroma [3]. Intracorneal ring segment (ICRS) implantation in pediatric keratoconus management is the second option. ICRS implantation is not preferred in children owing to the aggressive nature of pediatric keratoconus and the tendency of eye rubbing in children [4]
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