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Corneal Collagen Cross-Linking Under General Anesthesia for Pediatric Patients With Keratoconus and Developmental
Tessnim R Ahmad1, Neel D Pasricha2, Jennifer Rose-Nussbaumer3,4
1School of Medicine, University of California, San Francisco, San Francisco, CA.
Insights
Corneal collagen cross-linking (CXL) under general anesthesia is safe and effective for pediatric keratoconus patients with developmental delays, halting disease progression and improving visual outcomes.
Area of Science:
- Ophthalmology
- Pediatric Eye Care
- Corneal Diseases
Background:
- Keratoconus (KCN) is a progressive corneal ectasia affecting pediatric patients.
- Developmental delay or inability to cooperate necessitates alternative anesthetic approaches for KCN treatment.
- Topical anesthesia may be insufficient for certain pediatric populations requiring KCN intervention.
Purpose of the Study:
- To evaluate the clinical characteristics and outcomes of pediatric KCN patients undergoing corneal collagen cross-linking (CXL) under general anesthesia.
- To assess the safety and efficacy of CXL in patients with developmental delay or inability to cooperate with topical anesthesia.
Main Methods:
- Retrospective case series of pediatric KCN patients who underwent CXL under general anesthesia (January 2018 - April 2019).
- Comparison of baseline characteristics between developmentally delayed and non-delayed patients.
- Assessment of anesthesia/surgical complications, best corrected visual acuity (BCVA), keratometry (K) values, and eye-rubbing behavior post-operatively.
Main Results:
- Fourteen eyes of 9 pediatric patients were reviewed; 66.7% had developmental delay.
- No anesthesia or surgical complications were reported.
- Postoperative BCVA and K values remained stable at 6 months; 8 patients reduced or stopped eye rubbing.
Conclusions:
- Corneal collagen cross-linking (CXL) under general anesthesia is a safe and effective treatment for pediatric keratoconus.
- This approach successfully halts KCN progression in patients with developmental delay or cooperation challenges.
- CXL under general anesthesia offers a viable solution for managing KCN in non-cooperative pediatric populations.
Purpose:
To report the clinical characteristics and outcomes of pediatric patients with keratoconus (KCN) who underwent corneal collagen cross-linking (CXL) under general anesthesia for developmental delay or inability to cooperate with topical anesthesia.
Methods:
In this retrospective case series, we reviewed the medical charts of pediatric patients with KCN who had CXL under general anesthesia from January 2018 to April 2019. Baseline disease characteristics of patients with and without developmental delay were compared using the Pearson χ test and the t test. Main outcomes were anesthesia or surgical complications and postoperative best corrected visual acuity (BCVA), keratometry (K) values, and caregiver report of eye-rubbing behavior.
Results:
Fourteen eyes of 9 patients were reviewed. All were habitual eye rubbers at baseline. Six (66.7%) were developmentally delayed. Compared with patients without developmental delay, developmentally delayed patients were diagnosed and treated at older ages (16.0 vs. 13.9 years), experienced longer delays from diagnosis to surgery (20.7 vs. 8.8 weeks), and had lower BCVA (20/70 vs. 20/40), higher steep K values (54.0 vs. 50.9), and a higher incidence of corneal scarring (75.0% vs. 33.3%) and monocular vision loss (50.0% vs. 0.0%) at baseline, although these differences were not statistically significant. No anesthesia or surgical complications occurred. BCVA and K values were stable at postoperative month 6, with no clinically or statistically significant change observed for either measure. Eight patients decreased or stopped eye rubbing.
Conclusions:
We demonstrate the efficacy and safety of CXL under general anesthesia in halting the progression of KCN for pediatric patients with developmental delay or an inability to cooperate with the procedure until topical anesthesia.
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