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Three Different Protocols of Corneal Collagen Crosslinking in Keratoconus: Conventional, Accelerated and Iontophoresis

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Pediatric Crosslinking: Current Protocols and Approach.

Júlia Polido¹, Maria Emília Dos Xavier Santos Araújo^2,3, João G Alexander²

¹Department of Ophthalmology, Federal University of São Paulo (UNIFESP), Rua Botucatu, 806, Vila Clementino, São Paulo, SP, CEP 04023-062, Brazil. juliapolido@yahoo.com.br.

Ophthalmology and Therapy

|April 28, 2022

Summary

This summary is machine-generated.

Pediatric keratoconus (KC) requires effective treatments. This review examines various corneal crosslinking (CXL) techniques, including standard, accelerated, and transepithelial methods, to determine the safest and most effective options for children.

Keywords:

Corneal crosslinking Keratoconus Pediatric keratoconus

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Published on: April 3, 2016

Area of Science:

Ophthalmology
Corneal Surgery
Pediatric Eye Care

Background:

Pediatric keratoconus (KC) often presents more aggressively than in adults, increasing the risk of visual impairment.
Corneal crosslinking (CXL) is a primary treatment to halt KC progression.
Numerous CXL variations exist, necessitating a review of their pediatric efficacy and safety.

Purpose of the Study:

To provide an updated literature review on corneal crosslinking (CXL) techniques for pediatric keratoconus (KC).
To analyze the safety, efficacy, risks, and cost-effectiveness of current and emerging CXL methods in children.
To identify the optimal CXL approach for the pediatric KC population.

Main Methods:

Systematic review of English-language literature indexed in PubMed.
Analysis of various CXL protocols: Standard CXL (SCXL), Accelerated CXL (ACXL), Transepithelial CXL (TCXL).
Inclusion of novel techniques like contact lens-assisted CXL (CACXL), epithelial-island CXL (EI-CXL), and the Sub400 protocol, alongside riboflavin carrier variations (dextran-based vs. HPMC-based).

Main Results:

Standard CXL (Dresden Protocol) demonstrates safety and effectiveness in pediatric KC.
Accelerated CXL offers similar efficacy with reduced treatment time.
Transepithelial CXL aims to minimize complications and patient discomfort.
Emerging techniques address challenges with thinner corneas and offer alternative approaches.

Conclusions:

While several CXL techniques show promise for pediatric KC, definitive evidence on the safest and most effective method is still evolving.
Further research is needed to compare the long-term outcomes, safety profiles, and cost-effectiveness of different CXL protocols in pediatric patients.
Understanding the nuances of each CXL approach is crucial for optimizing treatment strategies in young KC patients.