CORNEAL COLLAGEN CROSS-LINKING IN PEDIATRIC PATIENTS – TEN-YEAR EXPERIENCE
Published 2022 - 26th ESCRS Winter Meeting
Reference: FP95 | Type: Abstracts | DOI: 10.82333/t4f3-cq61
Authors: Raquel Félix* 1 , Guilherme Gonçalves 2 , João Gil 3 , Esmeralda Costa 4 , Andreia Rosa 3 , Cristina Tavares 1 , Maria João Quadrado 3 , Joaquim Murta 3
1Ophthalmology Department,Centro Hospitalar e Universitário de Coimbra,Coimbra,Portugal, 2Ophthalmology Department,Faculdade de Medicina da Universidade de Coimbra,Coimbra,Portugal, 3Ophthalmology Department,Centro Hospitalar e Universitário de Coimbra,Coimbra,Portugal;Ophthalmology Department,Faculdade de Medicina da Universidade de Coimbra,Coimbra,Portugal;Ophthalmology Department,Unidade de Oftalmologia de Coimbra,Coimbra,Portugal, 4Ophthalmology Department,Centro Hospitalar e Universitário de Coimbra,Coimbra,Portugal;Ophthalmology Department,Faculdade de Medicina da Universidade de Coimbra,Coimbra,Portugal
Purpose
To evaluate the efficacy of corneal collagen cross-linking (CXL) in a population of pediatric patients aged 18 years or less with progressive KC, and to compare different CXL treatment protocols.
Setting
Multi-center, retrospective, cross-sectional study.
Methods
Patients with progressive KC, aged ≤ 18, who underwent CXL between 2010 and 2021 were reviewed. Different modalities of CXL were used: Standard CXL, Accelerated CXL, Combined CXL and partial topography-guided PRK (photorefractive keratectomy), and Customized CXL. Evaluation included best spectacle corrected visual acuity (BSCVA), manifest refraction, and Scheimpflug tomography evaluation. Baseline and follow-up values were compared.
Results
The study included 44 eyes of 33 patients, 26 (78.8%) male and 7 (21.2%) female. Mean age at time of CXL was 15.2±3.1 years [range 10-18]. Conventional CXL was performed in 9 eyes, and accelerated CXL in 14 eyes. Seven eyes performed combined CXL and simultaneous topography guided PRK. Fourteen eyes performed customized irradiation CXL. Epithelium was removed before CXL in all patients. Mean follow-up was 21.9±16.6 months [range 4-66]. At the last follow-up, mean BSCVA improved from 0.43±0.26 to 0.38±0.25 LogMAR (p=0.067). Preoperative mean spherical equivalent increased from -1.97±2.44 to -2.41±3.60 D (p=0.509) and cylinder decreased from 2.85±1.92 to 2.34±1.77 D (p=0.045). The flat keratometric values (K1) remained stable, from 48.04±4.87 to 48.74±5.12 D (p=0.358), as well as the steep keratometric values (K2), from 53.63±6.60 to 53.98±6.09 D (p=0.721), and maximum keratometry values (K max), from 62.45±10.38 to 62.20±10.01 D (p=0.764). Thinnest corneal thickness decreased from 452.03±39.63 to 423.59±43.17 µm (p<0.001). Mean spherical equivalent increased in conventional CXL eyes, and had a greater decrease in those having undergone combined CXL and PRK (p=0.042). Thinnest corneal thickness decreased more significantly in the combined CXL and PRK eyes (p<0.001). No other differences between different CXL protocols were significant. Success rate at the last follow-up was 90.9%, with 4 eyes (9.1%) showing progression after CXL: 2 following accelerated CXL and 2 following customized irradiation CXL.
Conclusion
CXL seems to halt the progression of KC in pediatric patients and result in stabilization of visual acuity and topographic parameters. Our results are in line with the published international series for pediatric KC, showing overall good results but a higher risk of progression than adult patients. Alternative protocols seem to be equally effective as standard-CXL in pediatric KC.