ACCELERATED TRANS-EPITHELIAL CROSS-LINKING IN THE TREATMENT OF KERATOCONUS IN CHILDREN: ABOUT 10 CASES

Keratoconus in children is characterised by its almost certain and rapid progression. CXL is currently the only treatment capable of halting the progression of the disease, and modified protocols (trans-epithelial and/or accelerated CXL) would make it possible to overcome the disadvantages of the standard protocol (epi-off), in particular the long duration of the procedure and the complications associated with corneal desepithelialisation.

to verify the efficacy and safety of accelerated trans-epithelial cross-linking in the management of keratoconus in children (≤16 years), by comparing pre- and post-operative clinical and topographical data and noting any complications.

ophtalmology B departement , ibn sina university hospital,RABAT,Morocco

We conducted a prospective analytical non-comparative study in the Ophthalmology Department of the Hospital for a total duration of 8 months and a follow-up period of 6 months. Eight patients aged under 16 with progressive keratoconus were recruited consecutively.
Methods: 10 eyes underwent accelerated (9mW/cm2 for 10 min) and trans-epithelial (CXL-ATE) CXL treatment.

Main endpoints: The change in maximum keratometry (Δ Kmax) after 6 months of CXL as the primary endpoint, as well as the change at six months after treatment, in Best Uncorrected Visual Acuity (BUCVA), Best Corrected Visual Acuity (BCVA), refraction, and other topographic data: Kmax, mean K, minimum pachymetry, anterior and posterior elevations at the thinnest point .

CXl-ATE treatment was effective in 9 eyes, i.e. an efficacy of 90%, with stability (-1D ≤ Δ Kmax ≤ 1D) in 6 eyes, improvement (Δ Kmax > -1D) in 3 eyes, and worsening (Δ Kmax > 1D) in one eye.
BUCVA and BCVA (in Log Mar) improved by 0.22 and 0.17 respectively at 6 months of treatment. The mean gain in spherical and cylindrical refraction was 0.23 D and 0.64 D respectively.
Mean keratometry (Km) decreased by 0.41 D, anterior elevation by 3 µm, posterior elevation by 2.2 µm, and minimum pachymetry remained stable. There were no cases of intra- or post-operative pain, haze or corneal infection.

In view of these results, which are confirmed by those in the literature, CXL-ATE appears to be an effective and safe protocol for treating keratoconus in children, and could represent a good alternative to overcome the disadvantages of the standard protocol. However, larger prospective and comparative studies with a longer follow-up period are still essential.