Clinical Outcomes Of Epi-On Crosslinking In The Pediatric Population
Published 2024 - 42nd Congress of the ESCRS
Reference: PP23.01 | Type: Free paper | DOI: 10.82333/zsty-y676
Authors: Gil Ben-David 1 , Olga Reitblat* 1 , Avital Adler 2 , Uri Elbaz 3
1Department of Ophthalmology,Rabin Medical Center,Petah Tikva,Israel, 2Department of Ophthalmology,Rabin Medical Center,Petah Tikva,Israel;Pediatric Ophthalmology Unit,Schneider Children’s Medical Center ,Petah Tikva,Israel, 3Department of Ophthalmology,Rabin Medical Center,Petah Tikva,Israel;Pediatric Ophthalmology Unit,Schneider Children’s Medical Center ,Petah Tikva,Israel;Faculty of Medicine,Tel Aviv University,Tel Aviv,Israel
Purpose
Management of pediatric keratoconus (KCN) is often challenging as children tend to exhibit higher incidence and faster rate of KCN progression. Pediatric patients are more susceptible to surgical complications and might have less tolerability to postoperative pain following crosslinking (CXL) treatment. The purpose of this study was to examine the effectiveness of an accelerated transepithelial (EPI-ON) CXL protocol, offering shorter operative time and reduced post-operative discomfort, in pediatric population.
Setting
Retrospective cohort study of children with KCN, at the cornea clinic of Schneider Children's Medical Center, treated with EPI-ON CXL protocol using the KXL system (Averdo, inc.).
Methods
The KXL machine projected pulsed UV-A light at 45mw/cm2 for 5 minutes and 20 seconds (1 second on, 1 second off), a total dose of 7.2J/cm2, following 10 minutes of riboflavin application. Medical records were reviewed for demographic data, clinical presentation, corneal tomography parameters, and visual outcomes. The primary outcome was disease progression defined as >1D of change in kMax at the end of the follow up.
Results
Study Included 13 patients (26 eyes), 16 (61.5%) male and 10 (38.5%) female with a mean age of 15.48±1.95 years. Mean duration of follow-up was 13.11±4.76 months. During follow up, progression of >1D in K-max was noted in 13 eyes (50%) and in K-average in 9 eyes (34.6%). Significant progression from prior to CXL to last follow-up was found in the mean central keratometry (K) (47.25± 4.043D vs. 49.16± 4.86D, respectively, p<0.001), K-max (51.86± 4.97D vs. 53.18± 6.07D, respectively, p=0.001), K-average (46.66± 2.94D vs. 47.54± 3.45D, respectively, p=0.001) and thinnest corneal thickness (480.88± 33.6µm vs. 475.17± 32.35µm, respectively, p=0.009). BCVA (logMAR) decreased non-significantly from 0.1±0.1 to 0.14±0.14, respectively (p=0.155).
Conclusions
Accelerated EPI-ON CXL has shown inferior efficacy compared to Epi-OFF CXL literature data in halting progression of Pediatric KCN. Nevertheless, half of the eyes show topographic stability.