Accelerated corneal crosslinking for treatment of progressive keratoconus in pediatric patients

Eur J Ophthalmol. 2017 May 11;27(3):319-325. doi: 10.5301/ejo.5000848. Epub 2016 Jul 20.

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.

MeSH terms

  • Adolescent
  • Child
  • Collagen / therapeutic use*
  • Corneal Topography
  • Corneal Transplantation / methods*
  • Cross-Linking Reagents / therapeutic use*
  • Cross-Sectional Studies
  • Disease Progression
  • Female
  • Humans
  • Keratoconus / pathology
  • Keratoconus / therapy*
  • Male
  • Photochemotherapy / methods*
  • Photosensitizing Agents / therapeutic use
  • Visual Acuity*
  • Young Adult

Substances

  • Cross-Linking Reagents
  • Photosensitizing Agents
  • Collagen