Corneal Collagen Cross-linking for Keratoconus in Pediatric and Developmentally Delayed Patients

Area of Science:

• Ophthalmology
• Corneal Surgery
• Pediatric Eye Care

Background:

• Keratoconus management in pediatric and developmentally delayed populations presents unique challenges.
• Corneal cross-linking (CXL) is the standard of care but requires adapted techniques for these patient groups.

Purpose of the Study:

• To present a clinical decision-making algorithm and surgical technique for CXL in children and developmentally delayed patients.
• To evaluate the outcomes and safety of CXL in these specific patient cohorts.

Main Methods:

• Retrospective chart review of patients undergoing CXL for keratoconus between October 2017 and April 2021.
• Data collected included demographics, preoperative/intraoperative/postoperative findings, CXL indications, complications, and visual acuity (VA).
• Epithelium-off CXL was performed, with general anesthesia and temporary central tarsorrhaphy utilized as indicated.

Main Results:

• Thirty-four patients (48 eyes) underwent CXL, including 21 with developmental delay (DD) and 13 without (NDD).
• No immediate postoperative complications were observed.
• A trend towards improved visual acuity was noted, with mean logMAR VA changing from 0.67 to 0.57 in the DD group (P=0.3) and 0.52 to 0.36 in the NDD group (P=0.13).

Conclusions:

• The presented technique facilitates timely diagnosis and safe CXL for keratoconus in children and individuals with DD.
• Temporary central tarsorrhaphy is a well-tolerated intervention for mitigating postoperative pain in these patients.
• This approach ensures effective management of keratoconus in challenging pediatric and developmentally delayed populations.