Long-Term Visual, Refractive and Topographic Outcomes of "Epi-off" Corneal Collagen Cross-Linking in Pediatric...

Area of Science:

• Ophthalmology
• Corneal Surgery
• Pediatric Eye Care

Background:

• Keratoconus is a progressive corneal ectasia affecting young patients.
• Corneal collagen cross-linking (CXL) is a standard treatment to halt keratoconus progression.
• Comparing standard and accelerated CXL protocols is crucial for optimizing pediatric keratoconus management.

Purpose of the Study:

• To compare visual, refractive, and topographic outcomes of standard versus accelerated corneal collagen cross-linking (CXL).
• To evaluate the efficacy of these CXL protocols in pediatric keratoconus patients.

Main Methods:

• A prospective, comparative observational study involving 68 eyes of 35 pediatric keratoconus patients (<18 years).
• Group I received standard Epi-Off CXL (3 mW/cm², 30 min); Group II received accelerated Epi-Off CXL (9 mW/cm², 10 min).
• Visual acuity, refractive error, simulated keratometry, and corneal pachymetry were assessed preoperatively and for 3 years postoperatively.

Main Results:

• No significant changes in uncorrected or corrected distance visual acuity were observed in either group after 3 years.
• Accelerated CXL showed a significant increase in spherical equivalent (p=0.012), while standard CXL demonstrated significant reductions in simulated keratometry (Sim K-1, K-max, K-mean) and corneal pachymetry (18.4 μm, p=0.001).
• No significant changes in postoperative cylinder or Q-value were noted for either procedure.

Conclusions:

• Both standard and accelerated CXL protocols are effective in managing pediatric keratoconus.
• The standard CXL procedure demonstrated superior outcomes in improving corneal topography and thickness compared to the accelerated protocol.