Accelerated Corneal Crosslinking for Treatment of Progressive Keratoconus in Pediatric Patients

Abstract

Purpose

To evaluate the safety and efficacy of accelerated corneal crosslinking (CXL) in patients with progressive keratoconus aged 18 years or less.

Methods

A total of 28 eyes from 19 patients with progressive keratoconus aged 18 years or less were enrolled. We divided participants into 2 groups according to corneal thickness (CT). Group 1 included 13 eyes of 8 patients with CT ≥450 µm; group 2 included 15 eyes of 11 patients with CT <450 µm. Each participant underwent accelerated CXL using 10-minute ultraviolet A irradiance at 9 mW/cm² for a total energy dose of 5.4 J/cm². The efficacy and safety of the procedure were assessed postoperatively at 1, 3, 6, and 12 months with Pentacam and visual acuity.

Results

In uncorrected visual acuity, group 1 showed a statistically significant +0.12 logMAR improvement at 3 months postoperatively (p = 0.003), and in group 2, there was a statistically significant +0.3 logMAR improvement at 1 month postoperatively (p = 0.005). In best-corrected visual acuity, there was a +0.15 logMAR (p<0.001) and +0.22 logMAR (p = 0.005) improvement in group 1 and group 2, respectively, at 12 months postoperatively. All mean keratometric values including K1 and K2 dropped by at least 1 D or remained stable (< ± 1 D) in both groups after accelerated CXL treatment.

Conclusions

The findings showed that accelerated CXL treatment seems to be effective in slowing or halting the progression of keratoconus and that no permanent apparent complications are noted 6 months after accelerated CXL.

Keywords

Accelerated collagen crosslinking Crosslinking Keratoconus Pediatric keratoconus Pentacam

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References

Rabinowitz

Keratoconus.

Surv Ophthalmol 199842(4)297–319

Davidson

Hayes

Hardcastle

Tuft

The pathogenesis of keratoconus.

Eye (Lond) 201428(2)189–195

Reeves

Stinnett

Adelman

Afshari

Risk factors for progression to penetrating keratoplasty in patients with keratoconus.

Am J Ophthalmol 2005140(4)607–611

Chatzis

Hafezi

Progression of keratoconus and efficacy of pediatric [corrected] corneal collagen cross-linking in children and adolescents.

J Refract Surg 201228(11)753–758

Wollensak

Spoerl

Seiler

Riboflavin/ultraviolet-a-induced collagen crosslinking for the treatment of keratoconus.

Am J Ophthalmol 2003135(5)620–627

Mazzotta

Balestrazzi

Traversi

et al.

Treatment of progressive keratoconus by riboflavin-UVA-induced cross-linking of corneal collagen: ultrastructural analysis by Heidelberg Retinal Tomograph II in vivo confocal microscopy in humans.

Cornea 200726(4)390–397

Tuft

Moodaley

Gregory

Davison

Buckley

Prognostic factors for the progression of keratoconus.

Ophthalmology 1994101(3)439–447

Léoni-Mesplié

Mortemousque

Touboul

et al.

Scalability and severity of keratoconus in children.

Am J Ophthalmol 2012154(1)56–62.e1

Yang

Rabinowitz

Longitudinal study of keratoconus progression.

Exp Eye Res 200785(4)502–507

10.

Vega-Estrada

Alió

Plaza Puche

Marshall

Outcomes of a new microwave procedure followed by accelerated cross-linking for the treatment of keratoconus: a pilot study.

J Refract Surg 201228(11)787–793

11.

Tomita

Mita

Huseynova

Accelerated versus conventional corneal collagen crosslinking.

J Cataract Refract Surg 201440(6)1013–1020

12.

Wernli

Schumacher

Spoerl

Mrochen

The efficacy of corneal cross-linking shows a sudden decrease with very high intensity UV light and short treatment time.

Invest Ophthalmol Vis Sci 201354(2)1176–1180

13.

Mita

Waring

IV Tomita

High-irradiance accelerated collagen crosslinking for the treatment of keratoconus: six-month results.

J Cataract Refract Surg 201440(6)1032–1040

14.

Magli

Forte

Tortori

Capasso

Marsico

Piozzi

Epithelium-off corneal collagen cross-linking versus transepithelial cross-linking for pediatric keratoconus.

Cornea 201332(5)597–601

15.

Kankariya

Kymionis

Diakonis

Yoo

Management of pediatric keratoconus - evolving role of corneal collagen cross-linking: an update.

Indian J Ophthalmol 201361(8)435–440

16.

Soeters

van der Valk

Tahzib

Corneal cross-linking for treatment of progressive keratoconus in various age groups.

J Refract Surg 201430(7)454–460

17.

Zotta

Moschou

Diakonis

et al.

Corneal collagen cross-linking for progressive keratoconus in pediatric patients: a feasibility study.

J Refract Surg 201228(11)793–799

18.

Arora

Gupta

Goyal

Jain

Results of corneal collagen cross-linking in pediatric patients.

J Refract Surg 201228(11)759–762

19.

Elbaz

Shen

Lichtinger

et al.

Accelerated (9-mW/cm2) corneal collagen crosslinking for keratoconus-A 1-year follow-up.

Cornea 201433(8)769–773

20.

Buzzonetti

Petrocelli

Transepithelial corneal cross-linking in pediatric patients: early results.

J Refract Surg 201228(11)763–767

21.

Vinciguerra

Albé

Frueh

Trazza

Epstein

Two-year corneal cross-linking results in patients younger than 18 years with documented progressive keratoconus.

Am J Ophthalmol 2012154(3)520–526

22.

Kodavoor

Arsiwala

Ramamurthy

One-year clinical study on efficacy of corneal cross-linking in Indian children with progressive keratoconus.

Cornea 201433(9)919–922

23.

Ozgurhan

Kara

Cankaya

Kurt

Demirok

Accelerated corneal cross-linking in pediatric patients with keratoconus: 24-month outcomes.

J Refract Surg 201430(12)843–849

24.

Caporossi

Mazzotta

Baiocchi

Caporossi

Denaro

Balestrazzi

Riboflavin-UVA-induced corneal collagen cross-linking in pediatric patients.

Cornea 201231(3)227–231

25.

Cınar

Cingü

Turkcu

et al.

Accelerated corneal collagen cross-linking for progressive keratoconus.

Cutan Ocul Toxicol 201433(2)168–171

26.

Holopainen

Krootila

Transient corneal thinning in eyes undergoing corneal cross-linking.

Am J Ophthalmol 2011152(4)533–536

27.

Greenstein

Shah

Fry

Hersh

Corneal thickness changes after corneal collagen crosslinking for keratoconus and corneal ectasia: one-year results.

J Cataract Refract Surg 201137(4)691–700

28.

Gutiérrez

Lopez

Villa-Collar

González-Méijome

Corneal transparency after cross-linking for keratoconus: 1-year follow-up.

J Refract Surg 201228(11)781–786

29.

Vinciguerra

Albè

Trazza

et al.

Refractive, topographic, tomographic, and aberrometric analysis of keratoconic eyes undergoing corneal cross-linking.

Ophthalmology 2009116(3)369–378

30.

Wollensak

Spoerl

Wilsch

Seiler

Endothelial cell damage after riboflavin-ultraviolet-A treatment in the rabbit.

J Cataract Refract Surg 200329(9)1786–1790

31.

Sharma

Maharana

Singh

Titiyal

Pseudomonas keratitis after collagen crosslinking for keratoconus: case report and review of literature.

J Cataract Refract Surg 201036(3)517–520

32.

Gokhale

Corneal endothelial damage after collagen cross-linking treatment.

Cornea 201130(12)1495–1498

33.

Pitts

Glenn

Glenn A.

Fry Award Lecture—1977. The ocular effects of ultraviolet radiation. Am J Optom Physiol Opt 197855(1)19–35

34.

Hafezi

Mrochen

Iseli

Seiler

Collagen crosslinking with ultraviolet-A and hypoosmolar riboflavin solution in thin corneas.

J Cataract Refract Surg 200935(4)621–624

35.

Kymionis

Grentzelos

Kankariya

et al.

Safety of high-intensity corneal collagen crosslinking.

J Cataract Refract Surg 201440(8)1337–1340

36.

Gatzioufas

Richoz

Brugnoli

Hafezi

Safety profile of high-fluence corneal collagen cross-linking for progressive keratoconus: preliminary results from a prospective cohort study.

J Refract Surg 201329(12)846–848

37.

Ozgurhan

Akcay

Kurt

Yildirim

Demirok

Accelerated Corneal Collagen Cross-Linking in Thin Keratoconic Corneas.

J Refract Surg 201531(6)386–390