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Bustamante-Arias A, Hernandez-Camarena JC, Rodriguez-Garcia A, Ruiz-Lozano RE, Rodriguez-Gutierrez LA, Valdez-Garcia JE. Outcomes of accelerated corneal cross-linking for pediatric and adult keratoconus: a comparative study. Int Ophthalmol 2024; 44:145. [PMID: 38498219 DOI: 10.1007/s10792-024-03080-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 02/16/2024] [Indexed: 03/20/2024]
Abstract
PURPOSE To compare the visual, refractive, and topographic outcomes of a high irradiance accelerated corneal crosslinking (ACXL) protocol after a 12-month follow-up between pediatric and adult patients with progressive keratoconus (KC). METHODS Retrospective, comparative, cohort study. Patients with KC were divided into two groups: pediatric (≤ 18 years) and adult (> 18 years). All of them were managed with epi-OFF ACXL (30 mW/cm2, 8 min, pulsed 1:1 on and off = 7.2 J/cm2). Visual, refractive, and topographic values were measured preoperatively and at 1, 3, 6, and 12 months postoperative. KC progression, defined as a Kmax increase of ≥ 1D during follow-up, was recorded. RESULTS Eighty-nine eyes (53 patients) were included for analysis; 45 (50.6%) eyes were from pediatric patients and 44 (49.4%) from adults. At one-year follow-up, pediatric patients experienced significantly higher rates of progression (22.2% vs. 4.5%, p = .014). Contrariwise, female gender (Beta = - 3.62, p = .018), a baseline uncorrected visual acuity of Snellen ≥ 20/60 (Beta = - 5.96, p = .007), and being ≥ 15 years at ACXL treatment (Beta = - 0.31, p = .021) were associated with non-progressive disease. A significant improvement in best-corrected visual acuity, Kmin, Km, and Kmax was recorded in both groups. Overall, 86.5% of eyes from both groups showed Kmax stabilization or improvement. CONCLUSIONS Despite the similarity in visual, refractive, and topographic outcomes in both groups, younger age was associated with KC progression after ACXL at one year of follow-up.
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Affiliation(s)
- Andres Bustamante-Arias
- Tecnologico de Monterrey, School of Medicine and Health Sciences, Institute of Ophthalmology and Visual Sciences, Hospital Zambrano Hellion, TecSalud, Av. Batallon de San Patricio #112. Col. Real de San Agustin, CP. 66278, Monterrey, N.L., Mexico
| | - Julio C Hernandez-Camarena
- Tecnologico de Monterrey, School of Medicine and Health Sciences, Institute of Ophthalmology and Visual Sciences, Hospital Zambrano Hellion, TecSalud, Av. Batallon de San Patricio #112. Col. Real de San Agustin, CP. 66278, Monterrey, N.L., Mexico
| | - Alejandro Rodriguez-Garcia
- Tecnologico de Monterrey, School of Medicine and Health Sciences, Institute of Ophthalmology and Visual Sciences, Hospital Zambrano Hellion, TecSalud, Av. Batallon de San Patricio #112. Col. Real de San Agustin, CP. 66278, Monterrey, N.L., Mexico
| | - Raul E Ruiz-Lozano
- Tecnologico de Monterrey, School of Medicine and Health Sciences, Institute of Ophthalmology and Visual Sciences, Hospital Zambrano Hellion, TecSalud, Av. Batallon de San Patricio #112. Col. Real de San Agustin, CP. 66278, Monterrey, N.L., Mexico
| | - Luis A Rodriguez-Gutierrez
- Tecnologico de Monterrey, School of Medicine and Health Sciences, Institute of Ophthalmology and Visual Sciences, Hospital Zambrano Hellion, TecSalud, Av. Batallon de San Patricio #112. Col. Real de San Agustin, CP. 66278, Monterrey, N.L., Mexico
| | - Jorge E Valdez-Garcia
- Tecnologico de Monterrey, School of Medicine and Health Sciences, Institute of Ophthalmology and Visual Sciences, Hospital Zambrano Hellion, TecSalud, Av. Batallon de San Patricio #112. Col. Real de San Agustin, CP. 66278, Monterrey, N.L., Mexico.
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Fasciani R, Scartozzi L, Bruzio S, Di Stefano G, Mosca L, Guccione L, Ciardiello A, Rizzo S. High-Fluence Epithelium-off Accelerated Pulsed Corneal Cross-linking (15 mW/cm 2; 7.2 J/cm 2) for Pediatric Keratoconus: A 3-Year Retrospective Analysis. J Refract Surg 2024; 40:e148-e155. [PMID: 38466760 DOI: 10.3928/1081597x-20240208-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/13/2024]
Abstract
PURPOSE To assess the safety and efficacy of treatment and secondarily determine the topographic changes, visual outcomes, and demarcation line depth after high-fluence pulsed light accelerated cross-linking (ACXL) in pediatric patients (younger than 18 years) with progressive keratoconus. METHODS This retrospective analysis included 32 eyes (25 children, aged 11 to 18 years), with progressive keratoconus treated with high-energy epithelium-off pulsed light ACXL (7.2 J/cm2, 15 mW/cm2, 12 minutes, 2 seconds on/1 second off). Corrected distance visual acuity (CDVA), Scheimpflug tomography, and anterior optical coherence tomography measurements were recorded preoperatively and 1, 2, and 3 years postoperatively. RESULTS A total of 32 eyes were included. Significant CDVA improvement, pachymetry, and maximum keratometry reduction were found at all follow-up visits. Mean keratometric values remained stable, and astigmatism showed a mild worsening (< 0.25 D) with statistical significance at 1 and 3 years. Total aberration showed discordant results and coma aberration had a slight improvement without statistical significance. The demarcation line depth was 265 ± 26 μm. Three patients developed mild haze without visual acuity loss. None of the patients underwent a second CXL procedure. CONCLUSIONS In pediatric patients, high-fluence epithelium-off pulsed light ACXL appears to be a safe and effective procedure to halt the progression of keratoconus, slightly improving the CDVA and keratometric values. [J Refract Surg. 2024;40(3):e148-e155.].
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Cankaya C, Gungor N. Outcomes after corneal crosslinking treatment in paediatric patients with keratoconus. Int Ophthalmol 2024; 44:56. [PMID: 38342827 DOI: 10.1007/s10792-024-02996-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Accepted: 10/19/2023] [Indexed: 02/13/2024]
Abstract
PURPOSE This study aims to determine the efficacy and safety of accelerated corneal crosslinking in children with keratoconus. METHODS The study enrolled 64 patients aged 16 years or younger, each contributing one eye for a total of 64 eyes for analysis. Participants underwent an accelerated form of corneal cross-linking with 15 min of ultraviolet A irradiation at a rate of 7 mW/cm2, resulting in a cumulative energy dose of 5.4 J/cm2. The primary outcome measures were best corrected visual acuity (BCVA) and corneal tomography at 6 and 12 months post-intervention. Parameters assessed included BCVA, spherical and cylindrical refraction, keratometry (K1 and K2), maximum keratometry (Kmax) and thinnest corneal thickness (TCT). These metrics were documented preoperatively and then again at 6 and 12 months postoperatively. In addition, any ocular or systemic conditions related to keratoconus were recorded for each participant. RESULTS The results showed an improvement in BCVA at 12 months after surgery. K1 showed a decrease at both post-operative follow-ups while K2 remained constant throughout the observation period. Kmax showed a notable decrease at the 12 month postoperative follow-up. Although the TCT showed an initial decrease, it reached a stable state after 12 months of crosslinking. Refractive values remained stable at all subsequent examinations. Notably, no complications such as corneal opacity, non-healing epithelial defects or corneal infections occurred during the follow-up period. The most common ocular comorbidity was allergic conjunctivitis (34.4%). CONCLUSION The findings suggest that accelerated corneal crosslinking treatment is effective in slowing or halting the progression of keratoconus. Furthermore, there were no persistent overt complications observed at 12 months after the procedure.
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Affiliation(s)
- Cem Cankaya
- Department of Ophthalmology, Inonu University School of Medicine, Malatya, Turkey.
| | - Nur Gungor
- Department of Ophthalmology, Inonu University School of Medicine, Malatya, Turkey
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Dervişoğulları S, Pelit A. Accelerated Corneal Cross-linking in Pediatric Patients with Progressive Keratoconus: 12-Month Follow-up Results. Niger J Clin Pract 2024; 27:131-135. [PMID: 38317046 DOI: 10.4103/njcp.njcp_598_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 12/01/2023] [Indexed: 02/07/2024]
Abstract
PURPOSE To evaluate effectiveness and safety of accelerated corneal cross-linking (CXL) in the treatment of keratoconus in pediatric patients. SETTING Tertiary care hospital. DESIGN Retrospective observational study. METHODS In this study, case series of patients 18 years old or younger with progressive keratoconus who underwent accelerated CXL were observed. All consecutive patients underwent accelerated CXL with setting of 9 mW/cm2 for 10-minute Ultraviolet-A radiation, corresponding to a total dose of 5.4 J/cm2. Preoperative and 12-month postoperative data including uncorrected distance visual acuity (UDVA), best-corrected distance visual acuity (BDVA), keratometry (K) measurements, mean spherical, and cylindrical refraction were evaluated. RESULTS The group consisted of 28 eyes from 14 patients (10 males and 4 females). Mean age of the patients was 16.9 years (11-18 years). UDVA did not change significantly from 0.71 ± 0.54 to 0.65 ± 0.43 logMAR (P = 0.41). BDVA improved significantly from 0.30 ± 0.35 to 0.21 ± 0.34 (P = 0.006). The steep K-value decreased from 48.4 ± 4.3 to 48.0 ± 4.6 diopters, but there was no significant change in steep K-value (P = 0.35). There was no significant change in flat and mean K-value (P > 0.05). Mean spherical and cylindrical refraction were not significantly altered (P > 0.05). One patient with vernal keratoconjunctivitis showed sterile peripheral corneal infiltrates. Patient was treated with topical corticosteroids, antibiotics, and artificial tears. CONCLUSION The findings revealed that accelerated CXL is an effective and safe procedure that halts the progression of keratoconus in pediatric patients.
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Affiliation(s)
- S Dervişoğulları
- Department of Ophthalmology, Başkent University Medical School, Adana Clinic and Research Center, Adana, Turkey
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Xanthopoulou K, Milioti G, Daas L, Munteanu C, Seitz B, Flockerzi E. Accelerated Corneal Crosslinking for Treatment of Keratoconus in Children and Adolescents under 18 Years of Age. Klin Monbl Augenheilkd 2023; 240:1131-1142. [PMID: 36436508 DOI: 10.1055/a-1933-3084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE To evaluate the efficacy of accelerated (9 mW/cm2, 10 min) epithelium-off (epi-off) corneal crosslinking (A-CXL) in keratoconus (KC) patients < 18 years of age. PATIENTS AND METHODS Our retrospective study included 41 eyes (25 male and 5 female patients, mean age 15.3 ± 1.2 years) who underwent A-CXL (9 mW/cm2, 10 min) because of progressive KC or critical KC at first presentation or asymmetrical finding in the partner eye. Outcome measures were best-corrected visual acuity (BCVA) and tomography readings (Pentacam HR, Oculus, Wetzlar, Germany), evaluated 2 years, 1 year, 6 months preoperatively, prior to surgery (pre-CXL) and 6 weeks, 6 months, 1 year, 2 years, > 2 years postoperatively (post-CXL). The demarcation line was assessed by anterior segment optical coherence tomography (SS-1000 and CASIA 2, Tomey, Nagoya, Japan). RESULTS Total deviation value increased statistically significantly 6 months pre-CXL to pre-CXL. Anterior steep, flat, and mean keratometry values showed a statistically significant increase 6 weeks post-CXL (p < 0.05), followed by a significant decrease until 2 years post-CXL for steep and mean keratometry. Kmax increased 6 weeks post-CXL without statistical significance and decreased significantly even > 2 years post-CXL (p < 0.0001). Posterior keratometry as well as anterior and posterior astigmatism did not show any significant changes post-CXL. Thinnest and apical pachymetry decreased significantly until 6 months post-CXL (p < 0.05) and remained stable > 2 years post-CXL (p > 0.05). BCVA decreased 6 weeks post-CXL but improved significantly > 2 years post-CXL (p = 0.003). The demarcation line reached an average depth of 52.1%. CONCLUSIONS Epi-off A-CXL stabilizes KC progression in patients < 18 years even > 2 years postoperatively and leads to a deep demarcation line. A "pseudoprogression" is observed up to the 6-week follow-up, which is not indicative of the long-term results.
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Affiliation(s)
- Kassandra Xanthopoulou
- Department of Ophthalmology, Saarland University Medical Center and Saarland University Faculty of Medicine, Homburg/Saar, Germany
| | - Georgia Milioti
- Department of Ophthalmology, Saarland University Medical Center and Saarland University Faculty of Medicine, Homburg/Saar, Germany
| | - Loay Daas
- Department of Ophthalmology, Saarland University Medical Center and Saarland University Faculty of Medicine, Homburg/Saar, Germany
| | - Cristian Munteanu
- Department of Ophthalmology, Saarland University Medical Center and Saarland University Faculty of Medicine, Homburg/Saar, Germany
| | - Berthold Seitz
- Department of Ophthalmology, Saarland University Medical Center and Saarland University Faculty of Medicine, Homburg/Saar, Germany
| | - Elias Flockerzi
- Department of Ophthalmology, Saarland University Medical Center and Saarland University Faculty of Medicine, Homburg/Saar, Germany
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Preethi B, Kumar KK, Babu GS, Sridhar S, Srinivasa KH. Outcomes of accelerated collagen cross linking in progressive paediatric keratoconus. Indian J Ophthalmol 2023; 71:1889-1893. [PMID: 37203050 PMCID: PMC10391506 DOI: 10.4103/ijo.ijo_1469_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2023] Open
Abstract
Purpose To determine the efficacy and safety of pediatric accelerated cross linking (CXL). Methods A prospective study on progressive keratoconus (KC) cases under ≤18 years of age. Sixty four eyes of thirty nine cases underwent epithelium-off accelerated CXL protocol. Visual acuity (VA), slit-lamp examination, refraction, pentacam reading of keratometry (K), corneal thickness, and thinnest location pachymetry were noted. Cases were followed up on days 1, 5, and at 1st, 3rd, 6th, and 12th-month post procedure. Results Statistically, significant improvement of the mean aided VA, K, and mean corneal astigmatism (p < 0.0001) was noted. Mean Kmax reading reduced from 55.5 ± 5.64 (47.4-70.4) diopter (D) preoperatively to 54.41 ± 5.51 (46-68.3) D at 12 months postaccelerated CXL. Two cases had progression. Complications encountered were sterile infiltrate and persistent haze. Conclusion Accelerated CXL is effective and efficacious in pediatric KC.
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Affiliation(s)
- B Preethi
- Department of Ophthalmology, Dr. Chandramma Dayananda Sagar Institute of Medical Education and Research Harohalli, Kanakapura, Karnataka, India
| | - K Kiran Kumar
- Department of Ophthalmology, Minto Ophthalmic Hospital, RIO, BMC&RI, Bengaluru, Karnataka, India
| | - G Suresh Babu
- Department of Ophthalmology, Minto Ophthalmic Hospital, RIO, BMC&RI, Bengaluru, Karnataka, India
| | - Sriya Sridhar
- Department of Community Medicine, BMC&RI, Bengaluru, Karnataka, India
| | - K H Srinivasa
- Department of Ophthalmology, Minto Ophthalmic Hospital, RIO, BMC&RI, Bengaluru, Karnataka, India
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Prasher P, Sharma A, Sharma R, Vig VK, Nirankari VS. Paediatric cornea crosslinking current strategies: A review. Adv Ophthalmol Pract Res 2023; 3:55-62. [PMID: 37846374 PMCID: PMC10577868 DOI: 10.1016/j.aopr.2022.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 11/13/2022] [Accepted: 11/16/2022] [Indexed: 10/18/2023]
Abstract
Background In the general population, 1 in 2000 people has keratoconus. Indians and other people from Southeast Asia have a higher incidence of keratoconus. Children with keratoconus typically present earlier in life and with a more severe disease. Rubbing the eyes has been identified as a risk factor. Children have a higher incidence and a faster rate of keratoconus progression. Visual rehabilitation in children with keratoconus is challenging. They have a low compliance with contact lens use. Many of these children require penetrating keratoplasty at an early age. Therefore, stopping the progression of keratoconus in children is of paramount importance. Main text Compared to treatment, keratoconus progression prophylaxis is not only preferable, but also easier. Corneal collagen cross-linking has been shown to be safe and effective in stopping its progression in children. The Dresden protocol, which involves central corneal deepithelization (7-9 mm), saturation of the stroma with riboflavin (0.25%), and 30 min UV-A exposure, has proven to be the most successful. Two significant disadvantages of the typical Dresden regimen are the prolonged operating time and the significant post-operative pain. Accelerated-CXL (9 mW/cm2 x 10 min) has been studied to reduce operative time and has been shown to be equally effective in some studies. Compared to accelerated CXL or traditional CXL, epi-off procedures, transepithelial treatment without the need for de-epithelialization and without postoperative discomfort, have been shown to be safer but less effective. Corneal crosslinking should only be performed after treating children with active vernal keratoconjunctivitis. Corneal opacity, chronic corneal edema, sterile infiltrates, and microbial keratitis have been reported after cross-linking of corneal collagen. Conclusions The "Dresden protocol", also known as the conventional corneal cross-linking approach, should be used to halt the progression of keratoconus in young patients. However, if the procedure needs to be completed more rapidly, accelerated corneal crosslinking may be considered. Transepithelial corneal cross-linking has been proven to be less effective at stabilizing keratoconus, although being more safer.
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Affiliation(s)
- Pawan Prasher
- Department of Ophthalmology, Sri Guru Ram Das Institute of Medical Sciences and Research, Amritsar, Punjab, India
| | - Ashok Sharma
- Cornea Centre, SCO 2463 - 2464, Sector 22 C, 160022, Chandigarh, India
| | - Rajan Sharma
- Cornea Centre, SCO 2463 - 2464, Sector 22 C, 160022, Chandigarh, India
| | - Vipan K. Vig
- Amritsar Eye Hospital, GNDU Shopping Complex, Amritsar, Punjab, India
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Somohano K, Alzaga-Fernandez AG. Controversies in Corneal Collagen Crosslinking: A Review of Investigational Crosslinking Protocols and Its Off-label Application. Int Ophthalmol Clin 2022; 62:51-62. [PMID: 36170222 DOI: 10.1097/iio.0000000000000426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Achiron A, El-Hadad O, Leadbetter D, Hecht I, Hamiel U, Avadhanam V, Tole D, Darcy K. Progression of Pediatric Keratoconus After Corneal Cross-Linking: A Systematic Review and Pooled Analysis. Cornea 2022; 41:874-878. [PMID: 34294638 DOI: 10.1097/ico.0000000000002808] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 05/15/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE Corneal collagen cross-linking (CXL) is an effective treatment to slow down keratoconus (KC) progression in adults. Several studies have also shown efficacious outcomes in pediatric populations, yet no systematic analysis has been performed and no accepted definition for progression is available in children after CXL. This study aimed to establish the most commonly used criteria for progression and to conduct a systematic review of the literature with pooled analysis to assess children's keratoconus progression after CXL. METHODS A systemic literature review combined with pooled analysis was performed on full-length studies of KC after CXL treatment in a pediatric population and the methods used to report progression were analyzed. RESULTS Thirty-seven studies (2078 eyes) were identified on the rates of KC progression after CXL. The most common method to report progression was increased Kmax, Kmean, or Ksteep by ≥1.0 diopter (78.3% of studies). Using these criteria, the mean pooled progression rate after epithelium-off CXL was 9.9% (95% confidence interval: 6.1% -14.6%, total pooled sample size: 1508 eyes) with high heterogeneity between studies [I 2 = 86.48% (95% confidence interval: 80.98 - 90.39), P < 0.0001]. CONCLUSIONS When considering KC progression after CXL in children, with an increase in Kmax, Kmean, or Ksteep ≥ 1.0 diopter, the progression risk was roughly 10%. We encourage clear quantitative reporting of KC progression in future studies evaluating CXL efficacy in pediatric populations.
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Affiliation(s)
- Asaf Achiron
- Bristol Eye Hospital, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Omar El-Hadad
- Bristol Eye Hospital, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom
- Faculty of Medicine, Alexandria University, Egypt
| | - Duncan Leadbetter
- Bristol Eye Hospital, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom
| | - Idan Hecht
- Department of Ophthalmology, Shamir Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; and
| | - Uri Hamiel
- Genetics Institute, Tel Aviv Sourasky Medical Center & Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Venkata Avadhanam
- Bristol Eye Hospital, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom
| | - Derek Tole
- Bristol Eye Hospital, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom
| | - Kieren Darcy
- Bristol Eye Hospital, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom
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Kosekahya P, Turkay M, Camgoz EB, Koc M, Toker MI. Long-term evaluation of posterior corneal surface parameters after accelerated corneal cross-linking with a comparison with uncross-linked keratoconic eyes. Int Ophthalmol 2022. [PMID: 35622219 DOI: 10.1007/s10792-022-02370-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Accepted: 05/02/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE To evaluate the 36 months changes in posterior corneal surface parameters in keratoconic eyes after accelerated corneal cross-linking and to compare the data with uncross-linked progressive and non-progressive keratoconic eyes. METHODS Thirty five cross-linked, 30 uncross-linked progressive, and 30 uncross-linked non-progressive keratoconic eyes were included. Maximum keratometry (Kmax), thinnest pachymetry, minimum radius of curvature back (Rminback), asphericity back, posterior elevation and corneal densitometry, back corneal higher order aberrations (HOAs), back surface deviation (Db), final D, posterior radius of curvature (PRC) and 'B' unit values were recorded at baseline and at the 12, 24, 36 months follow-up. Data were analyzed with repeated measures ANOVA and paired t-tests. RESULTS Kmax and thinnest pachymetry were significantly changed in the cross-linked and progressive uncross-linked groups. Rminback, asphericity back, and HOAs did not change in either group. Total posterior corneal densitometry improved; posterior elevation, Db and B unit worsened in the cross-linked group and did not change in the uncross-linked groups. PRC and final D worsened in the cross-linked and progressive uncross-linked groups, and did not change in the non-progressive group. CONCLUSION Despite a decreased Kmax, the posterior corneal surface parameters, posterior elevation values were determined to have significantly worsened in the cross-linked group and this increase was higher than in progressive uncross-linked eyes.
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Polido J, Dos Xavier Santos Araújo ME, Alexander JG, Cabral T, Ambrósio R, Freitas D. Pediatric Crosslinking: Current Protocols and Approach. Ophthalmol Ther 2022; 11:983-999. [PMID: 35482230 PMCID: PMC9114245 DOI: 10.1007/s40123-022-00508-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 03/31/2022] [Indexed: 11/24/2022] Open
Abstract
Keratoconus (KC) is likely to be more aggressive in the pediatric population, with a higher risk of progression and visual loss. Several techniques have been proposed for corneal crosslinking (CXL) so far. The standard CXL (SCXL) technique, or the Dresden Protocol, originally developed by Wollensak et al., has been shown to be safe and effective in the pediatric KC group. With similar efficacy to the conventional method, the accelerated CXL (ACXL) protocols proposed a reduced UVA exposure time by increasing the intensity of UVA irradiation. Transepithelial CXL (TCXL), considered an "epithelium-on" method, emerged as a strategy to improve safety and reduce postoperative complications and discomfort. For thinner corneas, we can highlight the use of hypoosmolar riboflavin and new studies, such as contact lens-assisted CXL (CACXL), the epithelial-island CXL (EI-CXL), and the Sub400 protocol. In addition to the different protocols used, another factor that changes CXL results is the type of carrier used: dextran-based or hydroxypropyl methylcellulose-based (HPMC) riboflavin solutions. There are several ways to perform a CXL surgery, and it is still unclear which method is the safest and most effective in the pediatric group. This review of the literature in English, available in PubMed, provides an update on corneal CXL in the pediatric KC group, exploring the data on the techniques currently used and under investigation, including their advantages, efficacy, safety profiles, risks, and cost analyses.
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Affiliation(s)
- Júlia Polido
- Department of Ophthalmology, Federal University of São Paulo (UNIFESP), Rua Botucatu, 806, Vila Clementino, São Paulo, SP, CEP 04023-062, Brazil.
| | - Maria Emília Dos Xavier Santos Araújo
- Department of Ophthalmology, Federal University of São Paulo (UNIFESP), Rua Botucatu, 806, Vila Clementino, São Paulo, SP, CEP 04023-062, Brazil.,Department of Ophthalmology, HSPE/IAMSPE, São Paulo, SP, Brazil
| | - João G Alexander
- Department of Ophthalmology, Federal University of São Paulo (UNIFESP), Rua Botucatu, 806, Vila Clementino, São Paulo, SP, CEP 04023-062, Brazil
| | - Thiago Cabral
- Department of Ophthalmology, Federal University of São Paulo (UNIFESP), Rua Botucatu, 806, Vila Clementino, São Paulo, SP, CEP 04023-062, Brazil.,Department of Ophthalmology EBSERH, HUCAM/CCS-UFES, Federal University of Espírito Santo (UFES), Vitória, ES, Brazil
| | - Renato Ambrósio
- Department of Ophthalmology, Federal University of São Paulo (UNIFESP), Rua Botucatu, 806, Vila Clementino, São Paulo, SP, CEP 04023-062, Brazil.,Department of Ophthalmology, The Federal University of the State of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Denise Freitas
- Department of Ophthalmology, Federal University of São Paulo (UNIFESP), Rua Botucatu, 806, Vila Clementino, São Paulo, SP, CEP 04023-062, Brazil
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Tian M, Jian W, Zhang X, Sun L, Shen Y, Zhou X. Predictive factors of the accelerated transepithelial corneal cross-linking outcomes in keratoconus. BMC Ophthalmol 2022; 22:7. [PMID: 34980018 PMCID: PMC8725418 DOI: 10.1186/s12886-021-02235-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 12/24/2021] [Indexed: 11/20/2022] Open
Abstract
Background This study aimed to evaluate the clinical outcomes and assess preoperative characteristics that may predict outcomes in keratoconus 1 year after accelerated transepithelial corneal cross-linking (ATE-CXL). Methods This prospective study included 93 eyes of 84 consecutive keratoconus patients with 1-year follow-up after ATE-CXL. Preoperative characteristics included corneal astigmatism, anterior chamber depth, anterior chamber volume, radius of curvature, posterior elevation, central corneal thickness (CCT), thinnest corneal thickness, steepest meridian keratometry, flattest meridian keratometry, and the maximum keratometry (Kmax). Data were obtained preoperatively and at 1, 3, 6, and 12 months postoperatively. The patient eyes were grouped into 3 subgroups according to CCT and Kmax values to observe the changes of keratoconus progression. Results All patients were successfully operated without complications at any follow-up time point. Mean changes of Kmax from baseline at 6 and 12 months were − 0.60 ± 2.21 D (P = 0.011) and − 0.36 ± 1.58 D (P = 0.030), respectively. Eyes with a thinner CCT and higher Kmax values exhibited a tendency for topographic flattening of ≥1.0 D (P = 0.003; P = 0.003). In the subgroup comparison, the Kmax values decreased significantly at 6 and 12 months after ATE-CXL in the group with CCT ≤ 450 μm (P = 0.018 and P = 0.045); the Kmax values of the group with Kmax > 65.0 D decreased significantly at 6 months postoperatively (P = 0.025). Conclusion ATE-CXL is a safe and effective treatment for keratoconus patients. Patients with thinner CCT and higher Kmax values are more likely to benefit from ATE-CXL.
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Affiliation(s)
- Mi Tian
- Eye Institute and Department of Ophthalmology, Eye and ENT Hospital, Fudan University, No. 19 Baoqing Road, Shanghai, 200031, China.,NHC Key Laboratory of Myopia (Fudan University); Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.,Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Weijun Jian
- Eye Institute and Department of Ophthalmology, Eye and ENT Hospital, Fudan University, No. 19 Baoqing Road, Shanghai, 200031, China.,NHC Key Laboratory of Myopia (Fudan University); Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.,Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Xiaoyu Zhang
- Eye Institute and Department of Ophthalmology, Eye and ENT Hospital, Fudan University, No. 19 Baoqing Road, Shanghai, 200031, China.,NHC Key Laboratory of Myopia (Fudan University); Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.,Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Ling Sun
- Eye Institute and Department of Ophthalmology, Eye and ENT Hospital, Fudan University, No. 19 Baoqing Road, Shanghai, 200031, China.,NHC Key Laboratory of Myopia (Fudan University); Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.,Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Yang Shen
- Eye Institute and Department of Ophthalmology, Eye and ENT Hospital, Fudan University, No. 19 Baoqing Road, Shanghai, 200031, China.,NHC Key Laboratory of Myopia (Fudan University); Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.,Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Xingtao Zhou
- Eye Institute and Department of Ophthalmology, Eye and ENT Hospital, Fudan University, No. 19 Baoqing Road, Shanghai, 200031, China. .,NHC Key Laboratory of Myopia (Fudan University); Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China. .,Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China.
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Alipour F, Ansari S, Dadman N, Hafezi F. Accelerated Corneal Collagen Cross-Linking in Pediatric Keratoconus. J Curr Ophthalmol 2021; 33:285-290. [PMID: 34765816 PMCID: PMC8579799 DOI: 10.4103/joco.joco_163_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 02/28/2021] [Accepted: 03/05/2021] [Indexed: 01/22/2023] Open
Abstract
Purpose To evaluate the visual, refractive, and topographic outcomes of accelerated corneal collagen cross-linking (CXL) in the pediatric age group. Methods In this retrospective case series study, 89 eyes of 56 patients with progressive keratoconus (KCN) who were under or equal to 18 years old at the time of surgery were included. All patients underwent accelerated corneal CXL. A thorough baseline and follow-up ophthalmic examination including uncorrected distance visual acuity, best corrected visual acuity (BCVA), slit-lamp and fundus examination, and corneal tomography by Scheimpflg camera Pentacam (Oculus, Wetzlar, Germany) were performed. Results The mean age of patients was 16.2 ± 1.8 years. Mean follow-up was 16.46 ± 11.6 months (range, 6-40 months). The mean BCVA improved significantly from 0.26 ± 0.26 to 0.16 ± 0.19 (logMAR) after accelerated CXL (P < 0.001). The mean corneal astigmatism based on refraction decreased from 3.69 ± 2.12 to 3.15 ± 1.86 after the intervention (P = 0.016). The mean maximum keratometry (Kmax) reduced significantly from 53.23 ± 6.07 diopter (D) to 52.23 ± 6.33 D (P = 0.047). The mean flat keratometry (K1) reduced from 46.37 ± 3.69 to 45.95 ± 3.65 after the intervention (P = 0.119). Conclusion Our study shows that accelerated CXL increases visual acuity and stabilizes or improves keratometric indices in pediatric patients with progressive KCN without any serious complication for a mean follow-up time of 16 months.
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Affiliation(s)
- Fateme Alipour
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Shabnam Ansari
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Nima Dadman
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Farhad Hafezi
- Department of Ophthalmology, Geneva University Hospitals, Geneva, Switzerland.,ELZA Institute, Dietikon, Switzerland.,Department of Ophthalmology, University of Wenzhou, Wenzhou, China
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Kobashi H, Hieda O, Itoi M, Kamiya K, Kato N, Shimazaki J, Tsubota K. Corneal Cross-Linking for Paediatric Keratoconus: A Systematic Review and Meta-Analysis. J Clin Med 2021; 10:jcm10122626. [PMID: 34203646 PMCID: PMC8232120 DOI: 10.3390/jcm10122626] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 05/28/2021] [Accepted: 06/03/2021] [Indexed: 12/20/2022] Open
Abstract
All corneal cross-linking techniques attenuated disease progression in patients with pediatric keratoconus for at least one year based on a meta-analysis. A standard and accelerated technique led to marked improvement in visual acuity. We determined the efficacy and safety of corneal cross-linking (CXL) in pediatric keratoconus by conducting a systematic review and meta-analysis. The PubMed and Cochrane databases were searched for relevant studies on the effects of standard, transepithelial, and/or accelerated CXL protocols in patients aged 18 years or younger. Standardized mean differences with 95% confidence intervals were calculated to compare the data collected at baseline and 12 months. The primary outcomes were maximum keratometry (Kmax) and uncorrected visual acuity (UCVA), and the secondary outcomes were the thinnest corneal thickness (TCT), best-corrected visual acuity (BCVA), and manifest refraction spherical equivalent or cylindrical refraction. Our search yielded 7913 publications, of which 26 were included in our systematic review and 21 were included in the meta-analysis. Standard CXL significantly improved the Kmax, UCVA, and BCVA, and significantly decreased the TCT. Accelerated CXL significantly improved UCVA and BCVA. In the transepithelial and accelerated-transepithelial CXL methods, each measurable parameter did not change after treatments. All CXL techniques attenuated disease progression in patients with pediatric keratoconus for at least one year. Standard and accelerated CXL led to marked improvement in visual acuity.
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Affiliation(s)
- Hidenaga Kobashi
- Department of Ophthalmology, School of Medicine, Keio University, Tokyo 160-8582, Japan; (N.K.); (K.T.)
- Tsubota Laboratory Inc., Tokyo 160-0016, Japan
- Correspondence: or
| | - Osamu Hieda
- Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan; (O.H.); (M.I.)
| | - Motohiro Itoi
- Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan; (O.H.); (M.I.)
| | - Kazutaka Kamiya
- Department of Ophthalmology, School of Medicine, University of Kitasato, Kanagawa 252-0329, Japan;
| | - Naoko Kato
- Department of Ophthalmology, School of Medicine, Keio University, Tokyo 160-8582, Japan; (N.K.); (K.T.)
- Department of Ophthalmology, Ichikawa General Hospital, Tokyo Dental College, Chiba 272-8513, Japan;
| | - Jun Shimazaki
- Department of Ophthalmology, Ichikawa General Hospital, Tokyo Dental College, Chiba 272-8513, Japan;
| | - Kazuo Tsubota
- Department of Ophthalmology, School of Medicine, Keio University, Tokyo 160-8582, Japan; (N.K.); (K.T.)
- Tsubota Laboratory Inc., Tokyo 160-0016, Japan
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Abstract
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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Affiliation(s)
| | | | | | - Zeba A Syed
- Cornea Service, Wills Eye Hospital, Philadelphia, PA, USA
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Marty AS, Jurkiewicz T, Febvay C, Mouchel R, Burillon C. [Safety and efficiency of epithelium-off accelerated corneal cross-linking for progressive keratoconus in pediatric patients]. J Fr Ophtalmol 2021; 44:828-834. [PMID: 33846032 DOI: 10.1016/j.jfo.2020.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 04/11/2020] [Accepted: 11/10/2020] [Indexed: 10/21/2022]
Abstract
In adults, the management of keratoconus has evolved in recent years to achieve a well-codified treatment algorithm. The technique of cross-linking (CXL) has allowed us to stabilize the progression of keratoconus and has been largely developed. It is very effective, with few postoperative complications. Currently, there is no specific keratoconus management protocol for children. As we already know that keratoconus usually evolves more rapidly in children, we might consider whether a stabilizing treatment should be proposed as first-line therapy at the time of diagnosis. We carried out a retrospective study including patients less than 18 years of age with keratoconus who consulted the ophthalmology department at Edouard Herriot hospital in Lyon between 2013 and 2017. The main study parameter was whether or not CXL was performed. The other parameters were gender, age, ethnicity, eye rubbing, presence or absence of atopic disease, maximum keratometry (Kmax), minimal pachymetry, best corrected visual acuity (BCVA) and spherical equivalent. Forty-eight eyes of 34 patients were included. We found that two-thirds of the patients were Caucasian boys. Half of the patients had allergies, and over 60% of patients rubbed their eyes regularly. Only six percent of patients had a family history of keratoconus. The mean age of the patients was 14 (7-18) years at the time of diagnosis. Thirty-four eyes of 22 patients underwent CXL, for a total of 71% of our cohort. No postoperative complications occurred. After CXL, there was no significant difference in minimum pachymetry (455.6±37.25μm vs. 453.45±42.6μm after treatment (P=0.71)) or Kmax (50.23±7.17D vs. 50.99±7.01D after treatment (P=0.058)). There was a significant improvement in BCVA (from 0.30±0.3LogMar to 0.17±0.17LogMar after CXL (P=0.024)) and spherical equivalent (-1.91±2.1D to -2.54±1.89D after treatment (P=0.009)). The mean duration of follow-up was 32.2 months (12-59). CXL shows long-term disease stabilization in children with keratoconus. Nevertheless, this technique is indicated only for progressive keratoconus. Early diagnosis and management are essential in this population where the disease is rapidly changing. Treatment of atopy and performance of corneal topography when a child has irregular astigmatism should become automatic for early detection of this disease.
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Affiliation(s)
- A-S Marty
- Clinique ophtalmologique Thiers, 330, avenue Thiers, 33100 Bordeaux, France.
| | - T Jurkiewicz
- Centre Vendôme, 13, rue Tronchet, 69006 Lyon, France; Hospices civils de Lyon, hôpital Pierre-Wertheimer, 59, boulevard Pinel, 69500 Bron, France
| | - C Febvay
- Service d'ophtalmologie, centre hospitalier de Besançon, 3, boulevard Alexandre-Fleming, 25030 Besançon, France
| | - R Mouchel
- Service d'ophtalmologie, Pavillon C, hôpital Edouard-Herriot, 5, place d'Arsonval, 69003 Lyon, France
| | - C Burillon
- Service d'ophtalmologie, Pavillon C, hôpital Edouard-Herriot, 5, place d'Arsonval, 69003 Lyon, France; Faculté de médecine Lyon Sud, Charles-Mérieux, rue du Grand-Revoyet, 69006 Oullins, France
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Ağca A, Tülü B, Yaşa D, Kepez Yıldız B, Sucu ME, Genç S, Fazıl K, Yıldırım Y. Accelerated corneal crosslinking in children with keratoconus: 5-year results and comparison of 2 protocols. J Cataract Refract Surg 2021; 46:517-523. [PMID: 32271294 DOI: 10.1097/j.jcrs.0000000000000101] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To evaluate long-term clinical results of 2 different accelerated corneal crosslinking (CXL) protocols in pediatric patients with keratoconus. SETTING Beyoğlu Eye Training and Research Hospital, Istanbul, Turkey. DESIGN Retrospective case-control study. METHODS Patients who were younger than 18 years were included in the study. Group 1 received 4 minutes of illumination at 30 mW/cm, and Group 2 received 5 minutes of illumination at 18 mW/cm. Uncorrected and corrected distance visual acuities, manifest refraction, corneal topographic parameters, and corneal higher-order aberrations (HOAs) were evaluated at baseline and during 1-, 3-, and 5-year follow-up visits. RESULTS A total of 143 eyes from 86 patients were included in the study. There were 30 eyes in Group 1 and 113 eyes in Group 2. The mean follow-up time was 4.15 ± 0.99 years. Mean keratometry (K) and/or maximum K progressed ≥1.00 diopter (D) in 7 eyes (23.3%) in Group 1 and 19 eyes (16.8%) in Group 2 (P = .411). Mean K and/or maximum K decreased ≥2.00 D in 2 eyes (6.7%) in Group 1 and 24 eyes (21.2%) in Group 2 (P = .06). In Group 1, there were no statistically significant differences in topographic parameters during follow-up. In Group 2, there was a statistically significant reduction in total HOA and coma during the 5-year visit when compared with the preoperative visit (P = .005 and P = .045, respectively). CONCLUSIONS Accelerated CXL is beneficial in terms of halting the progression of keratoconus in pediatric patients throughout 5 years of follow-up examinations. An increased irradiance with a reduced application time reduces the topographic effects of CXL.
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Affiliation(s)
- Alper Ağca
- From the Beyoğlu Eye Research and Training Hospital, Istanbul, Turkey
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Turhan SA, Yargi B, Toker E. Efficacy of Conventional Versus Accelerated Corneal Cross-linking in Pediatric Keratoconus: Two-Year Outcomes. J Refract Surg 2021; 36:265-269. [PMID: 32267958 DOI: 10.3928/1081597x-20200302-01] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 03/02/2020] [Indexed: 11/20/2022]
Abstract
PURPOSE To compare the efficacy and safety of accelerated corneal cross-linking (CXL) with conventional CXL in pediatric patients with keratoconus. METHODS Consecutive patients with keratoconus received either accelerated CXL (9 mW/cm2 irradiance for 10 minutes) or conventional CXL (3 mW/cm2 irradiance) for 30 minutes. Visual acuities (uncorrected [UDVA] and corrected [CDVA] distance visual acuity, logMAR), spherical error, cylindrical error, spherical equivalent, and keratometric values were recorded. Follow-up measurements were compared with baseline values. RESULTS The study enrolled 48 eyes: 22 eyes had accelerated CXL (mean age: 16.0 ± 1.7 years) and 26 eyes had conventional CXL (mean age: 15.7 ± 1.6 years). Compared with preoperative values, all mean keratometric values significantly improved in the accelerated CXL group (flat [K1]: Δ = -0.64 D, P < .0001, steep [K2]: Δ = -0.63 D, P = .009 and Kmax: Δ = -0.55 D, P = .028), but no significant changes were observed in the mean UDVA and CDVA. In the conventional CXL group, all mean keratometric values and CDVA significantly improved (K1: Δ = -0.65 D, P = .017, K2: Δ = -0.87 D, P = .006, Kmax: Δ = -1.47 D, P = .011). No significant changes were observed in refractive error in either CXL group. There were no significant differences in the keratometric readings, visual acuities, or refractive error between the two groups at the 2-year follow-up. CONCLUSIONS Both conventional and accelerated CXL protocols appear to be effective in stabilizing keratoconus progression in pediatric patients. Improved CDVA was also observed in the conventional CXL group. Accelerated CXL, with its advantage of shorter treatment duration, may be an alternative in pediatric patients. [J Refract Surg. 2020;36(4):265-269.].
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Fard AM, Reynolds AL, Lillvis JH, Nader ND. Corneal collagen cross-linking in pediatric keratoconus with three protocols: a systematic review and meta-analysis. J AAPOS 2020; 24:331-6. [PMID: 33279597 DOI: 10.1016/j.jaapos.2020.08.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 07/31/2020] [Accepted: 08/16/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Keratoconus is a bilateral progressive noninflammatory degenerative disease of the cornea characterized by corneal thinning, irregular astigmatism, and subsequent visual impairment. It has an aggressive course in children. This systematic review evaluates the efficacy of available corneal collagen cross-linking (CXL) protocols for stabilizing the cornea in pediatric patients with keratoconus. METHODS We searched all peer-reviewed publications from 2000 to 2019 indexed in PubMed, Google Scholars, Web of Science, and Cochrane's Database for the terms keratoconus and cross-linking. The following data were extracted from eligible studies: study design, type of intervention, number of the eyes and mean age of patients for each study, duration of follow-up period, mean pre- and postoperative uncorrected and corrected visual acuity, keratometric and aberrometric indices, were analyzed with RevMan 5.3 software. Intra-and intergroup post hoc analyses of outcome variables were performed using t tests. RESULTS A total of 28 studies, including 1,300 eyes, were reviewed. In conventional and accelerated epithelium-off techniques, there was a significant improvement in uncorrected and corrected visual acuities. Similarly, the keratometric indices improved significantly after CXL. Uncorrected visual acuity did not alter after CXL using transepithelial method. CONCLUSIONS Both conventional and accelerated collagen CXL of the cornea are effective therapeutic options in management of keratoconus in children.
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Amer I, Elaskary A, Mostafa A, Hazem HA, Omar A, Abdou A. Long-Term Visual, Refractive and Topographic Outcomes of "Epi-off" Corneal Collagen Cross-Linking in Pediatric Keratoconus: Standard versus Accelerated Protocol. Clin Ophthalmol 2020; 14:3747-3754. [PMID: 33177802 PMCID: PMC7650037 DOI: 10.2147/opth.s275797] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 09/29/2020] [Indexed: 12/27/2022] Open
Abstract
PURPOSE To compare the visual, refractive and topographic outcomes of standard and accelerated corneal collagen cross-linking (CXL) in pediatric keratoconus patients. METHODS Prospective, comparative observational study on 68 eyes of 35 pediatric keratoconus patients (<18 years). Patients were classified into two groups, group (I) included 34 eyes and received standard "Epi-Off" CXL (3 mW/cm2, 30 min.) and group (II) included 34 eyes and received accelerated "Epi-Off" CXL (9 mW/cm2, 10 min.). Uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), spherical equivalent (SE), simulated keratometry (Sim K-1, Sim K-2, K-max, K-mean), cylindrical (CYL), pachymetry and Q-value were evaluated preoperatively and for 3 years postoperatively. RESULTS Postoperative UDVA and CDVA did not significantly change in both groups after 3 years. Postoperative SE was increased significantly in accelerated CXL (p=0.012) with no significant change in the postoperative cylinder in both procedures. Standard CXL had greater "significant" effect in decreasing Sim K-1, K-max and K-mean. The mean reduction in postoperative corneal pachymetry (at thinnest location) was significant in standard CXL (18.4 μm) (p=0.001). No significant change was noticed in postoperative Q-value. CONCLUSION Standard and accelerated CXL protocols are efficient in pediatric keratoconus management with better outcomes in the standard procedure.
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Affiliation(s)
- Ibrahim Amer
- Ophthalmology Department, Faculty of Medicine, AL-Azhar University, Assiut, Egypt
| | - Abdelhakeem Elaskary
- Ophthalmology Department, Faculty of Medicine, AL-Azhar University, Assiut, Egypt
| | - Ali Mostafa
- Ophthalmology Department, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Hazem A Hazem
- Ophthalmology Department, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Ahmed Omar
- Ophthalmology Department, Faculty of Medicine, Assiut University, Assiut, Egypt.,University Hospitals Eye Institute and the Department of Ophthalmology and Visual Sciences, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Ahmed Abdou
- Ophthalmology Department, Faculty of Medicine, Assiut University, Assiut, Egypt
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Dimacali V, Balidis M, Adamopoulou A, Kozei A, Kozeis N. A Case of Early Keratoconus Associated with Eye Rubbing in a Young Child. Ophthalmol Ther 2020; 9:667-676. [PMID: 32542504 PMCID: PMC7406581 DOI: 10.1007/s40123-020-00264-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION Keratoconus usually presents during puberty and is considered rare in young children. METHODS Case report with clinical findings and computerized corneal tomography. RESULTS We report the case of an 8-year-old girl with early bilateral keratoconus who presented with allergic conjunctivitis and persistent eye rubbing. Although our patient did not exhibit steep keratometry, early cones and inferotemporal thinnest corneal thicknesses were detected in both eyes using Scheimpflug imaging (Oculus GmbH Pentacam, Wetzlar, Germany). Belin/Ambrósio total D values were 1.85 on the right and 2.11 on the left. Improvement in best-corrected visual acuity was noted after treatment of allergic eye disease, and corneal tomographic findings remained stable 4 months after initial consult. CONCLUSION This is a case of early diagnosed keratoconus in a young patient. Diagnosis of this condition in young children is challenging, as these patients are less likely to report visual complaints, and clinical examination is usually unremarkable. Keratoconus screening should be considered in children with atopy and eye rubbing behavior regardless of age, even in those with no other associated pathology and with negative family history.
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Affiliation(s)
- Victoria Dimacali
- Ophthalmica Institute of Ophthalmology and Microsurgery, Thessaloniki, Greece
- Makati Medical Center, Metro Manila, Philippines
| | - Miltos Balidis
- Ophthalmica Institute of Ophthalmology and Microsurgery, Thessaloniki, Greece
| | - Aspasia Adamopoulou
- Ophthalmica Institute of Ophthalmology and Microsurgery, Thessaloniki, Greece
| | - Athina Kozei
- Ophthalmica Institute of Ophthalmology and Microsurgery, Thessaloniki, Greece
- Pediatric Eye Center of Greece, Thessaloniki, Greece
- School of Pharmacology, University of Nicosia, Nicosia, Cyprus
| | - Nikolaos Kozeis
- Ophthalmica Institute of Ophthalmology and Microsurgery, Thessaloniki, Greece.
- Pediatric Eye Center of Greece, Thessaloniki, Greece.
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Ozer MD, Batur M, Mesen S, Tekın S, Seven E, Yasar T. Comparison of the efficacy of accelerated corneal cross-linking therapy in different pediatric age groups having progressive keratoconus. Int Ophthalmol 2020; 40:2651-8. [DOI: 10.1007/s10792-020-01446-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 05/23/2020] [Indexed: 10/24/2022]
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Iqbal M, Elmassry A, Saad H, AM Gad A, Ibrahim O, Hamed N, Saeed A, S. Khalil A, Tawfik M, Said A, Amer I, Nooreldin A, Said O, Reffat M, Anwar S, Badawi A. Standard cross-linking protocol versus accelerated and transepithelial cross-linking protocols for treatment of paediatric keratoconus: a 2-year comparative study. Acta Ophthalmol 2020; 98:e352-e362. [PMID: 31654497 PMCID: PMC7216930 DOI: 10.1111/aos.14275] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 09/18/2019] [Indexed: 01/14/2023]
Abstract
PURPOSE To compare the efficacy, safety and stability of standard epithelium-off cross-linking (SCXL) versus accelerated epithelium-off cross-linking (ACXL) and transepithelial epithelium-on cross-linking (TCXL) in the treatment of progressive keratoconus (KC) in children. METHODS This prospective multicentre controlled trial included 271 eyes (136 children) with grade 1-3 progressive KC who were randomized to undergo SCXL (n = 91, as a control group), ACXL (n = 92) or TCXL (n = 88). Uncorrected and corrected distance visual acuity, subjective refraction, pachymetry, keratometry and corneal topography measurements were recorded preoperatively and 6, 12 and 24 months postoperatively. RESULTS At 1 year, there was no significant difference in uncorrected distance visual acuity, refractive sphere, cylinder, spherical equivalent or Kmax between the ACXL and SCXL groups; however, during year 2, ACXL regressed while SCXL continued to improve. After 2 years, there were significant differences in all visual, refractive and keratometric components between SCXL and both ACXL and TCXL (p < 0.0001) and between ACXL and TCXL (p < 0.0001). KC progressed in 5.4% of patients who had ACXL and 28.4% of those who had TCXL but in none of those who had SCXL. Vernal keratoconjunctivitis was documented in 43.3% of eyes that progressed postoperatively. CONCLUSION SCXL was more effective for paediatric KC and achieved greater stability than either ACXL or TCXL, and ACXL was superior to TCXL. SCXL also achieved marked improvement in both myopia and spherical equivalent; however, these refractive outcomes were unpredictable and uncontrollable. TCXL had a 28.4% failure rate within 2 years. SCXL is preferable for management of paediatric KC.
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Affiliation(s)
- Mohammed Iqbal
- Department of OphthalmologyFaculty of MedicineSohag UniversitySohagEgypt
| | - Ahmed Elmassry
- Department of OphthalmologyFaculty of MedicineAlexandria UniversityAlexandriaEgypt
| | - Hisham Saad
- Department of OphthalmologyFaculty of MedicineTanta UniversityTantaEgypt
| | - Ahmed AM Gad
- Department of OphthalmologyFaculty of MedicineZagazig UniversityZagazigEgypt
| | - Ola Ibrahim
- Department of OphthalmologyFaculty of MedicineAin Shams UniversityCairoEgypt
| | - Noha Hamed
- Department of OphthalmologyFaculty of MedicineAin Shams UniversityCairoEgypt
| | - Ahmed Saeed
- Department of OphthalmologyFaculty of MedicineBenha UniversityBenhaEgypt
| | - Ahmad S. Khalil
- Department of OphthalmologyFaculty of MedicineZagazig UniversityZagazigEgypt
| | - Mohamed Tawfik
- Department of OphthalmologyMemorial Institute of OphthalmologyGizaEgypt
| | - Amr Said
- Department of OphthalmologyFaculty of MedicineAlexandria UniversityAlexandriaEgypt
| | - Ibrahim Amer
- Department of OphthalmologyFaculty of MedicineAlazhar UniversityAssuitEgypt
| | - Asaad Nooreldin
- Department of OphthalmologyFaculty of MedicineAlazhar UniversityAssuitEgypt
| | - Omar Said
- Department of OphthalmologyFaculty of MedicineFayoum UniversityFayoumEgypt
| | - Mohamed Reffat
- Department of OphthalmologyMansoura Ophthalmic HospitalMansouraEgypt
| | - Seif Anwar
- Department of OphthalmologyMansoura Ophthalmic HospitalMansouraEgypt
| | - Amani Badawi
- Department of OphthalmologyFaculty of MedicineMansoura UniversityMansouraEgypt
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Ahmad TR, Pasricha ND, Rose-Nussbaumer J, T Oatts J, M Schallhorn J, Indaram M. Corneal Collagen Cross-Linking Under General Anesthesia for Pediatric Patients With Keratoconus and Developmental Delay. Cornea 2020; 39:546-51. [PMID: 31725701 DOI: 10.1097/ICO.0000000000002197] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To report the clinical characteristics and outcomes of pediatric patients with keratoconus (KCN) who underwent corneal collagen cross-linking (CXL) under general anesthesia for developmental delay or inability to cooperate with topical anesthesia. METHODS In this retrospective case series, we reviewed the medical charts of pediatric patients with KCN who had CXL under general anesthesia from January 2018 to April 2019. Baseline disease characteristics of patients with and without developmental delay were compared using the Pearson χ test and the t test. Main outcomes were anesthesia or surgical complications and postoperative best corrected visual acuity (BCVA), keratometry (K) values, and caregiver report of eye-rubbing behavior. RESULTS Fourteen eyes of 9 patients were reviewed. All were habitual eye rubbers at baseline. Six (66.7%) were developmentally delayed. Compared with patients without developmental delay, developmentally delayed patients were diagnosed and treated at older ages (16.0 vs. 13.9 years), experienced longer delays from diagnosis to surgery (20.7 vs. 8.8 weeks), and had lower BCVA (20/70 vs. 20/40), higher steep K values (54.0 vs. 50.9), and a higher incidence of corneal scarring (75.0% vs. 33.3%) and monocular vision loss (50.0% vs. 0.0%) at baseline, although these differences were not statistically significant. No anesthesia or surgical complications occurred. BCVA and K values were stable at postoperative month 6, with no clinically or statistically significant change observed for either measure. Eight patients decreased or stopped eye rubbing. CONCLUSIONS We demonstrate the efficacy and safety of CXL under general anesthesia in halting the progression of KCN for pediatric patients with developmental delay or an inability to cooperate with the procedure until topical anesthesia.
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Valera-Cornejo DA, Vega-Estrada A, Alio JL. Invasive Pharmacology Outcomes with Different Corneal Cross-Linking Protocols: A Review. J Ocul Pharmacol Ther 2019; 35:475-490. [DOI: 10.1089/jop.2018.0144] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Affiliation(s)
| | - Alfredo Vega-Estrada
- Miguel Hernandez University, Alicante, Spain
- VIssum Ophthalmic Corporation, Alicante, Spain
| | - Jorge L. Alio
- Miguel Hernandez University, Alicante, Spain
- VIssum Ophthalmic Corporation, Alicante, Spain
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Ozer MD, Batur M, Mesen S, Tekin S, Seven E. Long-Term Results of Accelerated Corneal Cross-Linking in Adolescent Patients With Keratoconus. Cornea 2019; 38:992-7. [DOI: 10.1097/ico.0000000000001975] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Iqbal M, Elmassry A, Tawfik A, Abou Samra W, Elgharieb M, Elzembely H, Soliman A, Saad H, El Saman I, Saeed A, Farouk M, Tawfik T, Abou Ali A, Fawzy O. Analysis of the Outcomes of Combined Cross-Linking with Intracorneal Ring Segment Implantation for the Treatment of Pediatric Keratoconus. Curr Eye Res 2018; 44:125-134. [PMID: 30362837 DOI: 10.1080/02713683.2018.1540706] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
PURPOSE To analyze the visual and refractive outcomes of combined accelerated cross-linking with femtosecond laser intracorneal ring segment implantation for the treatment of pediatric keratoconus. MATERIALS AND METHODS This retrospective multicenter noncomparative clinical study included 63 eyes of 37 patients (age, 9-17 years) who underwent between August and September 2016 combined cross-linking with intracorneal ring segment implantation for keratoconus. Preoperative and postoperative (6, 12, and 18 months) uncorrected distance visual acuity (UDVA) and corrected distance visual acuity (CDVA), subjective refractions, keratometry (K), and pachymetry measurements were compared. RESULTS The postoperative spherical equivalent refraction was within ±1 D, ±2 D, and ±3 D in 19 (30.2%), 27 (42.9%), and 37 (58.8%) eyes, respectively. Only 27 eyes achieved the attempted preoperative spherical equivalent refraction. The mean spherical equivalent refraction significantly improved from -6.01 ± 2.97 to -3.13 ± 2.78 D postoperatively (P < 0.0001). The mean K average reading significantly decreased from 48.75 ± 4.25 to 46.65 ± 3.89 D postoperatively (P < 0.0001). The mean postoperative myopic, astigmatic, and spherical equivalent corrections were -2.17 ± 2.19, -1.52 ± 2.03, and -2.93 ± 2.35 D, respectively. The mean UDVA and CDVA showed significant improvements (0.89 ± 0.33 to 0.40 ± 0.28, P < 0.0001; 0.35 ± 0.31 to 0.25 ± 0.24, P = 0.004; respectively) at 18 months postoperatively. Keratoconus progression, segment migration, and segment extrusion were seen in four (6.4%), one (1.6%), and three (4.7%) eyes, respectively, probably contributing to the lower mean postoperative CDVA. CONCLUSION Cross-linking plus is only partially effective for pediatric keratoconus. Despite some improvements in vision and keratometry measures, it resulted in complications such as keratoconus progression, segment extrusion, and segment migration that affected the vision in some patients. These findings suggest an assessment of standard epithelium-off collagen cross-linking as a sole procedure to treat pediatric keratoconus in future studies.
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Affiliation(s)
- Mohammed Iqbal
- a Department of Ophthalmology, Faculty of Medicine , Sohag University , Sohag , Egypt
| | - Ahmed Elmassry
- b Department of Ophthalmology, Faculty of Medicine , Alexandria University , Alexandria , Egypt
| | - Ahmed Tawfik
- c Department of Ophthalmology, Faculty of Medicine , Zagazig University , Zagazig , Egypt
| | - Waleed Abou Samra
- d Department of Ophthalmology, Faculty of Medicine , Mansoura University , Mansoura , Egypt
| | - Mervat Elgharieb
- e Department of Ophthalmology, Faculty of Medicine , Suez Canal University , Suez , Egypt
| | - Hosam Elzembely
- f Department of Ophthalmology, Faculty of Medicine , Minia University , Minia , Egypt
| | - Ashraf Soliman
- g Department of Ophthalmology, Faculty of Medicine , Ain Shams University , Cairo , Egypt
| | - Hisham Saad
- h Department of Ophthalmology, Faculty of Medicine , Tanta University , Tanta , Egypt
| | - Islam El Saman
- a Department of Ophthalmology, Faculty of Medicine , Sohag University , Sohag , Egypt
| | - Ahmed Saeed
- i Department of Ophthalmology, Faculty of Medicine , Banha University , Banha , Egypt
| | - Mahmoud Farouk
- a Department of Ophthalmology, Faculty of Medicine , Sohag University , Sohag , Egypt
| | - Tarek Tawfik
- i Department of Ophthalmology, Faculty of Medicine , Banha University , Banha , Egypt
| | - Amin Abou Ali
- a Department of Ophthalmology, Faculty of Medicine , Sohag University , Sohag , Egypt
| | - Omar Fawzy
- j Department of Ophthalmology , Sohag Eye Hospital , Sohag , Egypt
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Sarac O, Caglayan M, Uysal BS, Uzel AGT, Tanriverdi B, Cagil N. Accelerated versus standard corneal collagen cross-linking in pediatric keratoconus patients: 24 months follow-up results. Cont Lens Anterior Eye 2018; 41:442-447. [PMID: 29910023 DOI: 10.1016/j.clae.2018.06.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Revised: 06/06/2018] [Accepted: 06/09/2018] [Indexed: 11/25/2022]
Abstract
PURPOSE To compare the 24 month visual, refractive, topographic and aberrometric results of the accelerated and standard corneal collagen cross-linking (CXL) in pediatric keratoconus patients. METHODS 87 eyes of 64 consecutive keratoconus patients under 18 years old with 24 month follow-up period following standard or accelerated CXL were included. 38 eyes received standard CXL (3 Mw/cm2, 30 min), while 49 eyes had accelerated CXL (9 mW/cm2, 10 min). Changes in the uncorrected (UCVA) and best corrected visual acuity (BCVA), spherical equivalent (SE), manifest astigmatism (MA), corneal topographic parameters, and corneal aberrations such as spherical aberration (SA), high order aberrations (HOAs), horizontal and vertical coma were evaluated. Corneal haze was graded and progression rate was assessed. RESULTS The difference between baseline and 24 months postoperative UCVA, BCVA, SimK (keratometry)-1, SimK-2, Kmax, and the corneal aberrations were not significantly different between the two groups (p > 0.05 for all). The mean reduction in thinnest corneal pachymetry from baseline to 24 months after CXL was higher in accelerated CXL group (p = 0.007). The progression rate was 13.1% in standard and 16.3% in accelerated group (p = 0.754). There were no differences in the grade of corneal haze between the two groups (p = 0.249). No complications were observed in the both groups. CONCLUSION The 24 month results of accelerated and standard CXL revealed that, the efficacy and safety of accelerated CXL were the same with standard CXL in pediatric keratoconus patients. As being a rapid procedure, accelerated CXL appears to be more benefical for pediatric patients.
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Affiliation(s)
- Ozge Sarac
- Ankara Training and Research Hospital, Department of Ophthalmology, Bilkent, Ankara, Turkey.
| | | | - Betul Seher Uysal
- Yildirim Beyazit University Faculty of Medicine, Department of Ophthalmology, Bilkent, Ankara, Turkey
| | | | - Burak Tanriverdi
- Yildirim Beyazit University Faculty of Medicine, Department of Ophthalmology, Bilkent, Ankara, Turkey
| | - Nurullah Cagil
- Yildirim Beyazit University Faculty of Medicine, Department of Ophthalmology, Bilkent, Ankara, Turkey
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Abstract
PURPOSE To comprehensively review the available published literature for cross-linking in the pediatric population. METHODS Review of the literature published in English in PubMed. RESULTS Two hundred ten publications were considered. One hundred fifteen were considered relevant to this review. CONCLUSIONS Studies of cross-linking in pediatric patients are sparse, with relatively short follow-up times, and mostly on small groups of patients. Treatment with cross-linking halts progression of keratoconus in the pediatric population, and early treatment seems to be cost-effective compared with later penetrating keratoplasty. Long-term effects and regression rates remain unclear, and further studies are needed in this population.
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Affiliation(s)
- Claudia Perez-Straziota
- Department of Ophthalmology, University of Southern California, Los Angeles, CA
- Cornea Eye Institute, Beverly Hills, CA
| | - Ronald N Gaster
- Cornea Eye Institute, Beverly Hills, CA
- Department of Ophthalmology, Gavin Herbert Eye Institute, University of California, Irvine, Irvine, CA
| | - Yaron S Rabinowitz
- Cornea Eye Institute, Beverly Hills, CA
- Ophthalmology Research, Cedars-Sinai Medical Center, Los Angeles, CA
- Department of Ophthalmology, Jules Stein Eye Institute, University of California Los Angeles, Los Angeles, CA
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Henriquez MA, Rodríguez AM, Izquierdo L Jr. Accelerated Epi-On Versus Standard Epi-Off Corneal Collagen Cross-Linking for Progressive Keratoconus in Pediatric Patients. Cornea 2017; 36:1503-8. [PMID: 28938381 DOI: 10.1097/ICO.0000000000001366] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To evaluate and compare the effectiveness and safety of accelerated transepithelial (A-epi-on) corneal collagen cross-linking (CXL) with standard CXL (epi-off) for children with progressive keratoconus. METHODS Prospective, cohort study including 61 eyes of 51 patients younger than 18 years with progressive keratoconus at Oftalmosalud Instituto de Ojos, Lima, Peru. A-epi-on CXL was performed for 36 eyes using 30 minutes of impregnation (0.25% riboflavin, 1.0% phosphate hydroxypropyl methylcellulose, 0.007% benzalkonium chloride) and 5 minutes of irradiation (18 mW/cm). Epi-off CXL was performed for 25 eyes using 30 minutes of impregnation (riboflavin 0.1% solution plus 20% dextran 500) and 30 minutes of irradiation (3 mW/cm). Scheimpflug imaging parameters were evaluated preoperatively and at 6 and 12 months postoperatively. RESULTS Mean uncorrected visual acuity improvement was 0.12 logarithm of the minimum angle of resolution (logMAR) for both groups (P = 0.09 for A-epi-on and P = 0.16 for Epi-off). Mean improvements in the best-corrected visual acuity were 0.09 logMAR (P = 0.05) and 0.06 logMAR (P = 0.05) at 12 months postoperatively for the A-epi-on group and the epi-off group, respectively. Mean maximum keratometry changes were +0.1 D (P = 0.62) and -0.94 D (P = 0.11) for the A-epi-on group and the epi-off group, respectively, at 12 months postoperatively. There were no significant differences between groups regarding changes in pachymetry and posterior elevation values (P > 0.05). Keratoconus progression was observed in 5.6% and 12% of eyes in the A-epi-on group and the epi-off group, respectively. CONCLUSIONS Accelerated epi-on CXL and standard epi-off CXL are safe and effective for stopping the progression of keratoconus at 12 months postoperatively.
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Subasinghe SK, Ogbuehi KC, Dias GJ. Current perspectives on corneal collagen crosslinking (CXL). Graefes Arch Clin Exp Ophthalmol 2018; 256:1363-1384. [PMID: 29623463 DOI: 10.1007/s00417-018-3966-0] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2017] [Revised: 02/20/2018] [Accepted: 03/23/2018] [Indexed: 12/13/2022] Open
Abstract
Corneal collagen crosslinking has revolutionized the treatment of keratoconus and post-refractive corneal ectasia in the past decade. Corneal crosslinking with riboflavin and ultraviolet A is proposed to halt the progression of keratectasia. In the original "Conventional Dresden Protocol" (C-CXL), the epithelium is removed prior to the crosslinking process to facilitate better absorption of riboflavin into the corneal stroma. Studies analyzing its short- and long-term outcomes revealed that although there are inconsistencies as to the effectiveness of this technique, the advantages prevail over the disadvantages. Therefore, corneal crosslinking (CXL) is widely used in current practice to treat keratoconus. In an attempt to improve the visual and topographical outcomes of C-CXL and to minimize time-related discomfort and endothelial-related side effects, various modifications such as accelerated crosslinking and transepithelial crosslinking methods have been introduced. The comparison of outcomes of these modified techniques with C-CXL has also returned contradictory results. Hence, it is difficult to clearly identify an optimal procedure that can overcome issues associated with the CXL. This review provides an up-to-date analysis on clinical and laboratory findings of these popular crosslinking protocols used in the treatment of keratoconus. It is evident from this review that in general, these modified techniques have succeeded in minimizing the immediate complications of the C-CXL technique. However, there were contradictory viewpoints regarding their effectiveness when compared with the conventional technique. Therefore, these modified techniques need to be further investigated to arrive at an optimal treatment option for keratoconus.
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Affiliation(s)
- Sandeepani K Subasinghe
- Department of Anatomy, University of Otago, P.O. Box 913, 270 Great King Street, Dunedin, 9054, New Zealand.
| | - Kelechi C Ogbuehi
- Ophthalmology Section, Department of Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - George J Dias
- Department of Anatomy, University of Otago, P.O. Box 913, 270 Great King Street, Dunedin, 9054, New Zealand
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Trief D, Suh LH. Refractive Surgery in Pediatric Patients. Curr Ophthalmol Rep 2017; 5:216-24. [DOI: 10.1007/s40135-017-0147-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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