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Published on: November 12, 2015
Long term results of accelerated corneal collagen cross-linking in pediatric keratoconus
Yasin Cinar1, Cagla Cilem Han1, Alparslan Sahin2
1Dicle University, Diyarbakır, Turkey.
Insights
Epithelium-off accelerated corneal collagen cross-linking (ACXL) effectively halts pediatric keratoconus progression. This treatment offers significant long-term visual and refractive benefits for young patients.
Area of Science:
- Ophthalmology
- Corneal Surgery
- Pediatric Eye Care
Background:
- Pediatric keratoconus (KC) is a progressive corneal ectasia that can lead to significant vision impairment.
- Early intervention is crucial to halt disease progression and preserve visual function in children.
- Accelerated corneal collagen cross-linking (ACXL) is a minimally invasive procedure aimed at strengthening the cornea.
Purpose of the Study:
- To evaluate the long-term visual, refractive, and corneal tomographic outcomes of epithelium-off ACXL in pediatric patients with progressive KC.
- To assess the efficacy of ACXL in stabilizing or improving vision and corneal shape in this population.
Main Methods:
- Retrospective study of pediatric patients (<18 years) with progressive KC undergoing epithelium-off ACXL.
- Comprehensive ophthalmic examinations including visual acuity, refraction, and corneal tomography were performed preoperatively and at 6-month intervals.
- Mean follow-up duration was 4.61 years.
Main Results:
- Significant improvements in uncorrected and best spectacle-corrected visual acuity were observed post-ACXL.
- Refractive cylinder and flat keratometry showed significant improvement, indicating corneal stabilization.
- While central corneal thickness decreased significantly, thinnest corneal thickness showed no significant change.
Conclusions:
- Epithelium-off ACXL is an effective treatment for halting keratoconus progression in pediatric patients.
- The procedure demonstrates long-term clinical benefits, including improved visual acuity and refractive stability.
- ACXL represents a valuable therapeutic option for managing progressive keratoconus in children.
Purpose:
To evaluate the long term visual, refractive, and corneal tomographic outcomes of epithelium-off accelerated corneal collagen cross-linking (ACXL) in the management of pediatric keratoconus (KC).
Methods:
This retrospective study included patients under 18 years old with progressive KC who underwent ACXL between 2012 and 2019 at Dicle University Hospital. Complete ophthalmic examination was performed including uncorrected distance visual acuity (UDVA), best spectacle-corrected distance visual acuity (CDVA), manifest refraction, and corneal tomography. Evaluations were performed preoperatively and at 6 months intervals postoperatively.
Results:
Forty-nine eyes of 49 patients were included in the study. The mean age of patients at the time of ACXL was 14.2 ± 1.8 (range: 9.5-17.3) years. Mean follow up was 4.61 ± 1.90 (range: 2.0-8.1) years. The mean LogMAR UDVA improved from 0.94 ± 0.41 to 0.81 ± 0.43, 0.69 ± 0.41, and 0.67 ± 0.33 after 1, 3, and 5 years respectively (p = 0.001). The mean LogMAR CDVA improved from 0.58 ± 0.36 to 0.46 ± 0.31, 0.34 ± 0.23, and 0.39 ± 0.27 after 1, 3, and 5 years respectively (p = 0.015). The mean refractive cylinder improved significantly from 6.01 ± 2.07 diopters (D) to 5.46 ± 1.87, 5.38 ± 2.18, and 5.02 ± 2.31 D after 1, 3, and 5 years respectively (p = 0.005). As compared to preoperative values, steep keratometry and maximum keratometry were not significantly different (p = 0.805 and 0.448, respectively) following ACXL, while flat keratometry significantly improved after ACXL (p = 0.012). Although central corneal thicknesses decreased significantly (p = 0.029), the decrease in thinnest corneal thickness was not statistically significant (p = 0.205).
Conclusion:
Epithelium-off ACXL seems to be effective for halting KC progression with long term clinical benefits in pediatric patients.
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