Case Series Of Consecutive Paediatric Keratoconus Patients With And Without Corneal Collagen Cross-Linking

Published 2022 - 40th Congress of the ESCRS

Reference: FPM10.07 | Type: Free paper | DOI: 10.82333/15yv-jz95

Authors: Lily Lai ¹ , Khayam Naderi ² , Korina Theodoraki ¹ , Stafford Sansome ¹ , Luis Onrubia Garcia ¹ , Ashmal Jameel ² , Jeffrey Lam* ³ , David O'Brart ² , Ailsa Ritchie ¹

¹St Thomas' Hospital,London,United Kingdom, ²St Thomas' Hospital,London,United Kingdom;King's College London,London,United Kingdom, ³King's College London,London,United Kingdom

Purpose

Keratoconus (KC) is the commonest corneal ectasia which can lead to progressive visual loss if left untreated. Corneal Collagen Cross-linking (CXL) has been shown to halt KC progression both in adults and children. In children, the risk of KC progression is higher, and careful monitoring is paramount to identify at risk cases. We present a case series of consecutive paediatric patients with KC who presented to our unit.

Setting

Retrospective, electronic note review of consecutive paediatric patients with KC in a United Kingdom teaching hospital.

Methods

Consecutive paediatric patients (<18 years) with a diagnosis of KC who had at least one 3-month follow up were included in this study (n=42). The electronic notes and Scheimpflug tomography measurements were reviewed. The indications for CXL included: an increase in K1, K2 or Kmax >1.0D, increase in back curvature >0.5D, reduced corneal thickness >16 microns, and patients with advanced KC. Best-corrected visual acuity (BCVA), K1, K2, Kmax, back curvature (BC), and thinnest corneal thickness (CT) were recorded at baseline, prior to CXL, and at the most recent clinic visit. CXL was performed using the Dresden protocol.

Results

80 eyes of 42 patients were included in the study. Mean age was 13.9 (SD 2.5). Mean follow-up time was 18 months. 23/80 (28.8%) did not show evidence of KC progression at their last follow up. 57/80 (71.2%) met the criteria for CXL, of which 49/57 underwent CXL, and 8/57 were awaiting procedure or had declined. 3/49 (6.1%) patients who underwent CXL showed evidence of further progression.

In patients who underwent CXL, the baseline and most recent measurements were: K1 (48.8 (baseline) vs 48.7 (recent), p=0.88), K2 (53.4 vs 53.1, p=0.35), Kmax (61.1 vs 59.7, p=0.02*), BC (-8.01 vs -8.17, p=0.06), and BCVA (0.32 vs 0.27, p=0.12).

Conclusions

CXL is effective in halting the progression of KC in paediatric patients. 3 (6.1%) patients who underwent CXL showed evidence of further progression. Close monitoring of paediatric KC patients is essential to identify progressing cases early and plan appropriate treatment to reduce the risk of visual loss.