PEDIATRIC CORNEAL COLLAGEN CROSS-LINKING: A CONCISE REVIEW ON DIFFERENT TECHNIQUES

Year 2024, Volume: 7 Issue: 2, 239 - 244, 30.06.2024

Ata Baytaroğlu Suzan Doğruya

Abstract

Objective: Since the first application of corneal collagen cross-linking (CXL) nearly 20 years ago, the technique has been modified and improved by many clinicians. Pediatric patients in particular are an important population focus for this treatment modality due to their susceptibility to rapid progression and irreversible damage. The standard CXL procedure has been updated to include transepithelial (TCXL), accelerated (ACXL), iontophoretic (ICXL) and synthesis of these approaches (ATCXL). In this review, we aimed to examine the current literature and determine the most effective and safe treatment method for the pediatric patient population.

Methods: The results found in Medline via PubMed using the keywords "keratoconus, pediatric keratoconus, corneal collagen cross-linking, pediatric corneal collagen cross-linking, pediatric cross-linking" in English language were reviewed. In addition to those listed in the search engine, relevant citations obtained from the literature search were also included. Retrospective and prospective articles with a follow-up period of at least 1 year were analyzed as part of the review.

Results: In our review, 18 prospective and 14 retrospective studies were analyzed. Eight of these studies were comparative and the follow-up period of all studies ranged between 1-5 years. The age distribution of all patients was between 9-18 years and CXL modalities were compared according to Kmax change and sustainability and presented in tables.

Conclusion: Although a consensus on a gold standard has not yet been reached, an increasing number of studies are being reported in favor of new techniques; however, the SCXL-Dresden protocol is still the safest and most effective treatment option.

Keywords

pediatric, keratoconus, cross-linking, cornea

PEDİATRİK KORNEAL KOLLAJEN ÇAPRAZ BAĞLAMA: FARKLI TEKNİKLER ÜZERİNE DERLEME

Abstract

Amaç: Korneal kolajen çapraz bağlama işleminin (CXL) yaklaşık 20 yıl önce ilk uygulanmasından bu yana, işlem tekniği bir çok klinisyen tarafından modifiye edilmiş ve geliştirilmiştir. Özellikle pediatrik hastaların hızlı progresyon ve geri dönüşümsüz hasarlara yatkın olmaları nedeniyle bu tedavi yöntemi için önemli bir popülasyon odağı olmaktadır. Standart CXL prosedürü yapılan güncellemelerle, transepitelyal (TCXL), hızlandırılmış (ACXL), iyontoforetik (ICXL) ve bu yaklaşımların sentezi (ATCXL) şeklinde uygulanabilmektedir. Bu derlememizde pediatrik hasta popülasyonu için güncel literatürün incelenmesi ve en etkili ve güvenilir tedavi yönteminin belirlenmesi hedeflenmiştir.

Yöntem: PubMed aracılığıyla Medline'da İngilizce dilinde "keratokonus, pediatrik keratokonus, korneal kollajen çapraz bağlama, pediatrik korneal kollajen çapraz bağlama, pediatrik çapraz bağlama" anahtar kelimeleri kullanılarak bulunan sonuçlar incelendi. Arama motorunda listelenenlerin dışında literatür taramasından elde edilen ilgili atıflar da dahil edildi. En az 1 yıllık takip süresi olan retrospektif ve prospektif makaleler derleme kapsamında analiz edildi.

Bulgular: Derlememizde 18 prospektif ve 14 retrospektif çalışma incelenmiştir. Bu çalışmaların 8 tanesi karşılaştırmalı vasıfta olup, tüm çalışmaların takip süreleri 1-5 yıl arasında değişmektedir. Tüm olguların yaş dağılımı 9-18 arasında olup, CXL modaliteleri Kmax değişimi ve sürdürülebilirliklerine göre karşılaştırılmış ve tablolarda sunulmuştur.

Sonuç: Henüz bir altın standart üzerinde konsensusa varılamamış olmakla beraber yeni teknikler lehine giderek artan sayıda çalışma bildirilmektedir; ancak SCXL-Dresden protokolü hala en güvenli ve en etkili tedavi seçeneği olarak bulunmaktadır..

Keywords

pediatrik, kolajen çapraz bağlama, keratokonus, kornea

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