Official ESCRS | European Society of Cataract & Refractive Surgeons


Effectivity of corneal cross-linking in paediatric keratoconus with or without previous treatment with intracorneal ring segments (ICRS)

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Session Details

Session Title: Presented Poster Session: Corneal Cross-Linking

Venue: Poster Village: Pod 3

First Author: : M.Roca Cabau SPAIN

Co Author(s): :    A. Del Hierro   S. Noval   A. Boto   I. Mogollon Giralt   L. Sanjuan Riera   R. Montejano Milner        

Abstract Details


To evaluate the topographic and visual acuity changes after epi-off corneal crosslinking (CXL) in pediatric patients with keratoconus; and analyze the effect of crosslinking in patients treated previously with ICRS.


We included all patients, aged less than 18, which underwent corneal collagen crosslinking in a tertiary referral hospital from 2010 to 2018. Ten of them had received previous ICRS. We excluded patients that were treated with CXL epi-on and those that had ICRS insertion during the year after the CXL.


Descriptive and retrospective study. 18 eyes of 16 patients (mean age, 15 years (SD1.9) diagnosed of keratoconus that underwent epithelium-off CXL were recruited. Conventional Dresden Protocol was used.  A complete ophthalmology exploration was performed to all patients including: Best corrected visual acuity (BCVA) (logMAR); corneal haze quantification or densiometry (DNS) by calculating the Scheimpflug image corresponding with K2; and topographic indices (average keratometry, kmax, minimum pachymetry and topographic cylinder) measured with Pentacam® All data were recorded at baseline, 1, 3, 6 and 12 months (M). We compared results between patients previously treated with ICRS and those treated just with CXL.


K-max decreased significantly from 48.2(SD3.2) to 45.8(SD2.3) after 1 year follow-up (p=0.032). Topographic cylinder, tended to decrease: from 4.2(SD1.6) to 3.2(SD1.2) at 12M There was a maintenance in BCVA from -0.21(SD0.18) to -0.13(SD0.16) at 12M A significant increase of the DNS was observed from 21.2(SD2.9) to 30(SD10.05) at 1M and 26.5(SD5.4) at 3M, that disappeared from 6M to base-line levels. When the subgroup analysis was performed, a significant decreased in corneal thickness was observed in CXL group that did not happen in those with previous ICRS (p=0,024) No complications were reported, except postoperative pain that was controlled with common analgesics.


Collagen crosslinking using Dresden protocol is an effective and safe treatment option for keratoconus in pediatric patients. Crosslinking not only stabilizes the condition but also improves the keratometry in pediatric patients. Corneal haze initially increase, however it disappear after 3M. Crosslinking is also a save procedure in patients with ICRS having an additive effect after the segments implantation. Our results suggest that the previous implantation of ICRS can prevent the thinning effect of the crosslinking, however this should be demonstrated in wider studies with longer follow up.

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