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Three Different Protocols of Corneal Collagen Crosslinking in Keratoconus: Conventional, Accelerated and Iontophoresis
Published on: November 12, 2015
Pulsed accelerated corneal cross-linking for pediatric keratoconus: a prospective study from the Indian subcontinent
Parul Jain1, Arun Mehta1, Ritu Arora2
1Department of Ophthalmology (Guru Nanak Eye Centre), Maulana Azad Medical College, New Delhi, India.
Insights
Pulsed accelerated corneal cross-linking (PACXL) improved vision and stabilized corneas in 85% of pediatric keratoconus patients within 12 months. This time-efficient treatment showed no endothelial toxicity, offering a safe early-intervention option.
Area of Science:
- Ophthalmology
- Corneal Surgery
- Pediatric Eye Care
Background:
- Keratoconus is a progressive corneal ectasia affecting children and young adults.
- Early intervention is crucial to prevent vision loss in pediatric keratoconus.
- Standard corneal collagen cross-linking protocols can be time-consuming for pediatric patients.
Purpose of the Study:
- To evaluate the 12-month visual, refractive, and tomographic outcomes of pulsed accelerated corneal collagen cross-linking (PACXL).
- To determine the safety and efficacy of PACXL in an Indian pediatric cohort with progressive keratoconus.
- To assess visual acuity, refractive error, and corneal topography changes post-PACXL.
Main Methods:
- Prospective interventional study of 40 eyes in 31 children (<18 years) with progressive keratoconus.
- Epithelium-off PACXL performed using the PXL Platinum 330 system (9 mW/cm², 10s on/5s off).
- Outcomes measured at 12 months included visual acuity, Kmax, refraction, pachymetry, and endothelial cell density.
Main Results:
- Best spectacle-corrected visual acuity improved significantly (p=0.005), and uncorrected visual acuity improved (p<0.001).
- Mean maximum keratometry (Kmax) decreased slightly, and refractive cylinder reduced significantly (p=0.036).
- 85% of eyes achieved topographic stabilization; transient sterile infiltrates occurred in 7.5% with no infectious keratitis or endothelial loss.
Conclusions:
- PACXL demonstrated significant visual improvement and high topographic stabilization rates in pediatric keratoconus.
- The procedure is safe, with no observed endothelial toxicity in the Indian pediatric cohort.
- PACXL offers a time-efficient and effective early-intervention strategy for pediatric keratoconus.
Purpose:
To evaluate the 12 month visual, refractive, and tomographic outcomes of pulsed accelerated corneal collagen cross-linking (PACXL) in children with progressive keratoconus and to determine its safety and efficacy in an Indian pediatric cohort.
Methods:
This was a prospective interventional study including 40 eyes of 31 children (< 18 years) with progressive keratoconus and a minimum corneal thickness ≥ 400 µm. All eyes underwent epithelium-off PACXL (9 mW/cm2, 10 s on/5 s off, total 5.4 J/cm2) using the PXL Platinum 330 system. The total procedure time was around 45 min i.e. 30 min of riboflavin instillation and 15 min of UV-A irradiation. Standard postoperative steroid and antibiotic regimens were followed. Outcomes at 12 months included uncorrected (UCVA) and best spectacle-corrected visual acuity (BSCVA, logMAR), maximum keratometry (Kmax), manifest refraction, pachymetry, endothelial cell density, and postoperative complications.
Results:
The mean age was 15.4 ± 1.5 years (64.5% male). At 12 months, mean BSCVA improved from 0.31 ± 0.21 to 0.23 ± 0.22 logMAR (p = 0.005) and UCVA from 0.79 ± 0.46 to 0.71 ± 0.47 logMAR (p < 0.001). Mean Kmax decreased from 57.38 ± 6.22 to 56.8 ± 5.6 D. Median refractive cylinder reduced from - 2.0 to - 1.12 D (p = 0.036). Mean thinnest pachymetry declined from 446.15 ± 25.5 to 398.7 ± 43.7 µm (p < 0.001), indicating stromal compaction or possible stromal volume loss. Endothelial cell density remained stable (2843.9 ± 247 → 2828.3 ± 234 cells/mm2; p = 0.092). At 12 months, 34/40 eyes (85%) were stable; 6 eyes (15%) progressed (defined as Kmax increase ≥ 1.0 D), all with advanced baseline disease. Three eyes (7.5%) developed transient sterile infiltrates that resolved with topical steroids. No infectious keratitis or endothelial loss occurred.
Conclusions:
Pulsed accelerated CXL provided significant visual improvement and 85% topographic stabilization at 12 months in pediatric keratoconus, with no endothelial toxicity. It offers a time-efficient and safe early-intervention option for children in whom standard protocols are less feasible.
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