Outcome indicators for cross linking in pediatric keratoconus

Denise Wajnsztajn; Or Shmueli; Yehuda Tarnovsky; Joseph Frucht-Pery; Abraham Solomon

doi:10.3389/fmed.2023.1149641

Outcome indicators for cross linking in pediatric keratoconus

Front Med (Lausanne). 2023 May 12:10:1149641. doi: 10.3389/fmed.2023.1149641. eCollection 2023.

Authors

Denise Wajnsztajn¹, Or Shmueli¹, Yehuda Tarnovsky¹, Joseph Frucht-Pery¹, Abraham Solomon¹

Affiliation

¹ Department of Ophthalmology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.

Abstract

Purpose: To evaluate the predictive factors for successful corneal collagen cross-linking (CXL) in pediatric patients with Keratoconus (KC).

Methods: This retrospective study was conducted using a prospectively built database. Patients (18 years old or younger) underwent CXL for KC between 2007 and 2017, with a 1-year follow-up period or longer. The outcomes included changes in Kmax (delta [Δ] Kmax = Kmax_last - Kmax_pre) and LogMAR visual acuity (ΔLogMAR = LogMAR_last - LogMAR_pre).The effects of CXL type (accelerated or non-accelerated), demographics (age, sex, background of ocular allergy, ethnicity), preoperative LogMAR visual acuity, maximal corneal power (Kmax), pachymetry (CCT_pre), refractive cylinder, and follow-up (FU) time on the outcomes were analyzed.

Results: One hundred thirty-one eyes of 110 children were included (mean age, 16 ± 2 years; range, 10-18 years). Kmax and LogMAR improved from baseline to last visit: from 53.81 D ± 6.39 D to 52.31 D ± 6.06 D (p < 0.001) and from 0.27 ± 0.23 LogMAR units to 0.23 ± 0.19 LogMAR units (p = 0.005), respectively. A negative ΔKmax (meaning corneal flattening) was associated with a long FU, low CCT_pre, high Kmax_pre, high LogMAR_pre, and non-accelerated CXL on univariate analysis. High Kmax_pre and non-accelerated CXL were associated with negative ΔKmax in the multivariate analysis.A negative ΔLogMAR (meaning vision improvement) was associated with a high LogMAR_pre in univariate analysis.

Conclusion: CXL is an effective treatment option in pediatric patients with KC. Our results showed that the non-accelerated treatment was more effective than the accelerated treatment. Corneas with advanced disease had a greater effect on CXL.

Keywords: cross-linking; efficacy; keratoconus; outcome indicators; pediatric; predictive factors.