Bilateral Simultaneous Collagen Cross Linking In Pediatric Keratoconus: 2 Year Follow Up Result
Published 2024 - 42nd Congress of the ESCRS
Reference: PP23.03 | Type: Free paper | DOI: 10.82333/hvfp-qv06
Authors: Swati Tomar* 1 , Devansh Virdi 2
1OPHTHALMOLOGY,SWANETRA EYE HOSPITAL ,JAIPUR,India, 2OPHTHALMOLOGY,NIMS UNIVERSITY ,JAIPUR,India
Purpose
To study long term clinical outcome of Accelerated Corneal Collagen Cross-linking or ACXL procedure in progressive keratoconus in pediatric population less than 18 years by analysis of parameters such as DCVA or Distance Corrected Visual Acuity, Steep K, Average K and Pachymetry at 2 years followup
Setting
Retrospective cohort study design involving 39 patient or 78 eyes with pediatric keratoconus showing progression on Pentacam and deteriorating DCVA
Methods
Keratoconus diagnosis was made by topographic features of Pentacam
All patients underwent bilateral simultaneous epi off ACXL procedure under topical anaesthesia
The outcome defined successful if corneal flattening was seen as 1 D change in Steep K or improvement in refractive cylinder within 1 year accompanied by flattening or stability in pachymetry alongside improvement or stability in DCVA at end of 2 years.
Failure defined as steepening of cornea seen as 1 D increase in Steep K or worsening of refractive cylinder within 1 year with decrement in DCVA at end of 2 years
Primary outcomes were Steep K or Kmax and Uncorrected visual acuity while secondary outcomes were Thinnest corneal thickness and Distance corrected visual acuity
Results
Out of 78 eyes of 39 patients, 85 percent patients showed improvement in DCVA, 74 percent showed improvement in Steep K values, 64 percent showed improvement in Average k and 73 percent showed flattening in pachymetry values at last follow up. All patients had mild corneal haze which lasted upto 3 to 4 months of procedure. No patient had any corneal complications on post operative follow up
Conclusions
ACXL is considered as an effective, safe and acceptable procedure in pediatric keratoconus
Steep K is arguably the most essential parameter when considering keratoconus progression ACXL significantly improved Steep K, DCVA, Average K and decreased TCT
ACXL requiring shorter operative and anaesthesia time, is preferable in children
Bilateral simultaneous ACXL has an advantage in pediatric patients over adults because children are too young to cooperate while conscious and have fear of undergoing sequential other eye procedure due to temporary side effects of first eye CXL