Safety and Efficacy of Corneal Crosslinking Treatment in Children with Keratoconus

Year 2021, Volume: 18 Issue: 1, 145 - 148, 28.04.2021

Deniz Özarslan Özcan Sait Coşkun Özcan

https://doi.org/10.35440/hutfd.885032

Abstract

Background: To evaluate the safety and efficacy of corneal crosslinking (CXL) treatment in children with keratoconus.
Materials and Methods:A total of 45 eyes of 34 children with progressive keratoconus were included in this study. CXL was performed according to the conventional method. Manifest refraction, uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), corneal topography values, and endothelial cell density (ECD) were evaluated at baseline and 24-month follow-up.
Results:The mean age of the patients was 14.6 ± 3.5 years. The mean spherical equivalent readings were statistically significantly decreased at 24 months (p=0.016). There was a significant improvement in the mean UDVA and CDVA at 24 months (p=0.002, p=0.006, respectively). The mean K1 and K2 were statistically significantly reduced at 24 months postoperatively (p=0.004, p=0.006, respectively). There was no significant alteration in ECD at any follow-up examination. No significant sight-threatening complications were observed.
Conclusions: The CXL procedure seem to be safe and effective in stabilizing keratoconus progression in children within a follow-up of 24 months.

Keywords

keratoconus, corneal crosslinking, pediatric keratoconus

Keratokonuslu Çocuklarda Korneal Çapraz Bağlama Tedavisinin Güvenilirlik ve Etkinliği

Abstract

Amaç: Keratokonuslu çocuklarda korneal çapraz bağlama (CXL) tedavisinin güvenilirlik ve etkinliğini değerlendirmek.
Materyal ve metod: Bu çalışmaya ilerleyici keratokonuslu 34 çocuğun 45 gözü dahil edildi. CXL, geleneksel yönteme göre uygulandı. Manifest kırılma, düzeltilmemiş uzak görme keskinliği (UDVA), düzeltilmiş uzak görme keskinliği (CDVA), korneal topografi değerleri ve endotel hücre yoğunluğu (ECD) başlangıçta, 12 ve 24 aylık takiplerde değerlendirildi.
Bulgular: Hastaların ortalama yaşı 14.6 ± 3.5 yıldı. Ortalama sferik eşdeğer değerler, 12 ve 24 aylık vizitlerde istatistiksel olarak anlamlı şekilde azaldı (sırasıyla p= 0.039, p=0.016). Ortalama UDVA ve CDVA'da 12 (sırasıyla p=0,003, p=0,005) ve 24 aylık (sırasıyla p=0.002, p=0.006) vizitlerde anlamlı bir iyileşme vardı. Ortalama K1 ve K2 ameliyat sonrası 12. ayda (sırasıyla p=0.013, p=0.012) ve 24. ayda (sırasıyla p=0.004, p=0.006) istatistiksel olarak anlamlı şekilde azaldı. Herhangi bir takip muayenesinde ECD'de önemli bir değişiklik olmadı. Görmeyi tehdit eden önemli bir komplikasyon gözlenmedi.
Sonuç: CXL prosedürü, 24 aylık takip süresi içinde çocuklarda keratokonus progresyonunu stabilize etmede güvenli ve etkili görünmektedir.

Keywords

keratokonus, kornea çapraz bağlanması, pediatrik keratokonus

References

• 1.Rabinowitz YS. Keratoconus. Surv Ophthalmol. 1998; 42(4):297-319.
• 2.El-Khoury S, Abdelmassih Y, Hamade A, Slim E, Cherfan CG, Chelala E, et al. Pediatric keratoconus in a tertiary referral center: incidence, presentation, risk factors, and treatment. J Refract Surg. 2016; 32(8):534-41.
• 3.Sabti S, Tappeiner C, Frueh BE. Corneal cross-linking in a 4-year-old child with keratoconus and Down syndrome. Cornea. 2015; 34(9):1157-60.
• 4.Vinciguerra P, Albe E, Frueh BE, Trazza S, Epstein D. Two-year corneal cross-linking results in patients younger than 18 years with documented progressive keratoconus. Am J Ophthalmol. 2012; 154(3):520-6.
• 5.Leoni-Mesplie S, Mortemousque B, Touboul D, Malet F, Praud D, Mesplie N, et al. Scalability and severity of keratoconus in children. Am J Ophthalmol. 2012; 154(1):56-62.
• 6.Wollensak G, Spoerl E, Seiler T. Riboflavin/ultraviolet-a-induced collagen crosslinking for the teratment of keratoconus. Am J Ophthalmol. 2003; 135(5):620-7.
• 7.O’Brart DP, Kwong TQ, Patel P, McDonald RJ, O’Brart NA. Long-term follow-up of riboflavin/ultraviolet A (370 nm) corneal collagen cross-linking to halt the progression of keratoconus. Br J Ophthalmol.2013; 97(4):433-7.
• 8.Ghanem RC, Santhiago MR, Berti T, Netto MV, Ghanem VC. Topographic, corneal wavefront and refractive outcomes 2 years after collgen crosslinking for progressive keratoconus. Cornea. 2014; 33(1):43-51.
• 9.Raiskup-Wolf F, Hoyer A, Spoerl E, Pillunat LE. Collagen crosslinking with riboflavin and ultraviolet-A light in keratoconus: long-term results. J Cataract Refract Surg. 2008; 34(5):796-801.
• 10.Krumeich JH, Kezirian GM. Circular keratotomy to reduce astigmatism and improve vision in stage I and II keratoconus. J Refract Surg. 2009; 25:357–65.
• 11.Caporossi A, Mazzotta C, Baiocchi S, Caporossi T, Denaro R. Age-related long-term functional results after riboflavin UV A corneal cross-linking. J Ophthalmol. 2011; 2011:608041.
• 12.Soeters N, van der Valk R, Tahzib NG. Corneal cross-linking for treatment of progressive keratoconus in various age groups. J Refract Surg. 2014; 30(7):454-60.
• 13.Barbisan PRT, Pinto RDP, Gusmao CC, de Castro RS, Arieta CEL. Corneal collagen cross-linking in young patients for progressive keratoconus. Cornea. 2020; 39(2):186-91.
• 14.Vinciguerra R, Romano M, Carnesasca Fl, Azzolini C, Trazza S, Morenghi E, et al. Corneal cross-linking as a treatment for keratoconus: four-year morphologic and clinical outcomes with respect to patient age. Ophthalmology. 2013; 120(5):908-16.
• 15.Uçakhan ÖÖ, Celik Buyuktepe T, Yavuz Z, Asbell PA. Pediatric versus adult corneal collagen crosslinking: long-term visual, refractive, tomographic and aberrometric outcomes. Curr Eye Res. 2021; 46(1):14-22.
• 16.Wise S, Diaz C, Termote K, Dubord PJ, McCarthy M, Yeung SN. Corneal cross-linking in pediatric patients with progressive keratoconus. Cornea. 2016; 35(11):1441-3.
• 17.Toprak I, Yaylali V, Yildirim C. Visual, topographic, and pachymetric effects of pediatric corneal collagen cross-linking. J Pediatr Ophthalmol Strabismus. 2017; 54(12):84-9.
• 18.Padmanabhan P, Rachapalle Reddi S, Rajagopal R, Natarajan R, Iyer G, Srinivasan B, et al. Corneal collagen cross-linking for keratokonus in pediatric patients-long-term results. Cornea. 2017; 36(2):138-43.
• 19.Sarac O, Caglayan M, Cakmak HB, Cagil N. Factors influencing progression of keratoconus 2 years after corneal collagen cross-linking in pediatric patients. Cornea 2016; 35(12):1503-7.
• 20.Ozer MD, Batur M, Mesen S, Tekin S, Seven E, Yasar T. Comparison of the efficacy of accelerated corneal cross-linking in different pediatric age groups having progressive keratoconus. Int Ophthalmol. 2020; 40(10):2651-8.