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Three Different Protocols of Corneal Collagen Crosslinking in Keratoconus: Conventional, Accelerated and Iontophoresis
Published on: November 12, 2015
Three-year follow-up of accelerated transepithelial corneal cross-linking for progressive paediatric keratoconus
Mi Tian1,2, Weijun Jian1,2, Xiaoyu Zhang1,2
1Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China.
Insights
Accelerated transepithelial corneal cross-linking (ATE-CXL) is safe and effective for children with progressive keratoconus. This treatment stabilizes corneal thickness and keratometry over 36 months, improving visual acuity.
Area of Science:
- Ophthalmology
- Corneal Surgery
- Pediatric Eye Care
Background:
- Keratoconus is a progressive condition affecting corneal shape.
- Early intervention in pediatric patients is crucial to prevent vision loss.
- Accelerated transepithelial corneal cross-linking (ATE-CXL) offers a less invasive approach to halt progression.
Purpose of the Study:
- To evaluate the long-term safety and efficacy of ATE-CXL in children with progressive keratoconus.
- To assess visual acuity, refractive error, and corneal biomechanical parameters over 36 months.
Main Methods:
- A cohort of 41 pediatric patients (53 eyes) underwent ATE-CXL.
- Evaluated corrected distance visual acuity (CDVA) and manifest refraction preoperatively and postoperatively.
- Utilized Pentacam and optical coherence tomography for serial measurements of keratometry, pachymetry, and corneal thickness.
Main Results:
- CDVA improved significantly at 36 months (p=0.025).
- Corneal keratometry and central thickness remained stable throughout the 36-month follow-up (p>0.05).
- Posterior corneal elevation showed initial stability but increased at 36 months (p<0.05).
Conclusions:
- ATE-CXL demonstrates safety and efficacy in pediatric progressive keratoconus.
- The procedure leads to stable corneal parameters, including keratometry and thickness, over three years.
- ATE-CXL is a viable treatment option for managing pediatric keratoconus progression.
Purpose:
To investigate the long-term safety and efficacy of accelerated transepithelial cornealcross-linking (ATE-CXL) in children with progressive keratoconus.
Methods:
Fifty-three eyes of 41 paediatric patients (34 boys, 7 girls; mean age 14.81±1.96 years) undergoing ATE-CXL were enrolled in the study. Corrected distance visual acuity (CDVA) and manifest refraction were assessed preoperatively and 36 months postoperatively. Corneal keratometry, corneal thickness and posterior elevation were measured using Pentacam preoperatively and 1, 6, 12 and 36 months postoperatively. Pachymetry and epithelial thicknesses were measured using optical coherence tomography preoperatively and 6, 12, and 36 months postoperatively.
Results:
Thirty-six months postoperatively, CDVA improved from 0.32±0.28 to 0.26±0.25 in logarithm of the minimum angle resolution (p=0.025). Maximum keratometry was 58.73±9.70 D preoperatively and 59.20±10.24, 58.28±9.33, 57.88±9.99 and 58.98±10.79 D at 1, 6, 12 and 36 months postoperatively throughout the 36-month follow-up period (p>0.05). Similarly, corneal central thickness, which was 492.42±33.83 µm postoperatively, also remained stable during the 36-month follow-up (p>0.05). Both posterior central elevation and posterior highest elevation were stable at 12 months after ATE-CXL (p>0.05), but increased at 36 months postprocedure (p<0.05). Corneal pachymetry and epithelial thicknesses remained stable throughout the follow-up period (p>0.05).
Conclusions:
ATE-CXL is a safe and effective treatment in paediatric progressive keratoconus patients, leading to stable keratometry and corneal thickness throughout the 36-month follow-up.
