Predicting Factors For Efficacy Of Corneal Collagen Cross-Linking For Pediatric Keratoconus

Published 2022 - 40th Congress of the ESCRS

Reference: FPM10.04 | Type: Free paper | DOI: 10.82333/m47c-0f87

Authors: Abraham Solomon* ¹ , Or Shmueli ¹ , Yehuda Tarnovski ¹ , Joseph Frucht-Pery ¹ , Denise Wajnsztajn ¹

¹Ophthalmology,Hadassah-Hebrew University Medical Center,Jerusalem,Israel

Purpose

To evaluate predicting factors of success in corneal collagen cross-linking (CXL) for pediatric keratoconus (KC) patients (18 years old or younger) in a single tertiary referral center.

Setting

A retrospective study based on a prospectively built database, at a tertiary referal center.

Methods

Patients (18 years old or younger) who had CXL for KC from 2007 to 2017 with 1-year follow-up or more were included.

Univariate and multivariate analysis of the effects of CXL type (Accelerated or Non-Accelerated), demographics (age, gender, background of ocular allergy, ethnicity) and pre-operative LogMAR visual acuity, maximal corneal power (Kmax), pachymetry (CCT_pre) and refractive cylinder as well as follow-up (FU) time on outcome measures.

The main outcome measures were: The final change of Kmax (Delta [Δ] Kmax = Kmax_last – Kmax_pre) and the final change in LogMAR visual acuity (ΔLogMAR = LogMAR_last – LogMAR_pre)

Results

131 eyes from 110 children were included (mean age 16±2 years, range 10 to 18 years). Kmax and LogMAR significantly improved from baseline to last visit: from 53.81 D ± 6.39 D to 52.31 D ± 6.06 D (p<0.001) and from 0.27 ± 0.23 LogMAR units to 0.23 ± 0.19 LogMAR units (p=0.005), respectively. Negative ΔKmax (meaning corneal flattening) was associated with long FU, low CCT_pre, high Kmax_pre, high LogMAR_pre and non-accelerated CXL in univariate analysis. Of those, high Kmax_pre and non-accelerated CXL were associated with negative ΔKmax in multivariate analysis. Negative ΔLogMAR (meaning vision improvement) was only associated with high LogMAR_prein univariate analysis.

Conclusions

CXL for pediatric KC patients is an effective treatment. Our results showed that the topographic CXL effect is time-dependent and that non-accelerated treatment is more effective than the accelerated protocol. Corneas with advanced disease had greater CXL effect.