Corneal CXL in Children With Progessive Keratoconus

Author do not have any financial interest in the surgical procedure or the medicines used in this study

Authors

• Ashok Sharma, Cornea Centre, Chandigarh, India

• Verinder S Nirankari, Eye Consultants of Maryland

To present visual, refractive and topographic outcome after corneal cross-linking (CXL) for progressive keratoconus in children below 18 years

Purpose

Patients & Methods

• Study Design: A retrospective non-comparative interventional case series

• Patients with progressive keratoconus aged below 18 years treated with CXL

• Data on pre & post CXL mean Sim K, spherical equivalent, cylinder, UCVA and BCVA retrived and analysed

• CCT > than 400 microns in all eyes• No intra-operative complications were noted• Mean follow-up: 25.78 ± 10.5 months. 

Surgical Procedure

• Dresden protocol CXL with instrument calibration before each treatment

• Epithelium off technique• Intra operative pachymetery • Un-cooperative children and those

below 12 years under general anaesthesia

Corneal CXL : Pre-op Data

• K1: 46.36±3.49 • K2: 50.66±4.56• Km: 48.36±3.72

• BCVA : 0.06±0.12 • Astig : 4.13±2.02D• Pachy: 453±36 µ

Pre-op Corneal Topography

CXL : Results

Keratoconus stable : 29(91%) eyes

One eye developed corneal hydrops

One showed progression topography

Another showed significant decrease in corneal thickness

PRE-OP POST-OP45

46

47

48

49

50

51

47.96±3.40 46.95

±4.07

50.5±4.38

49.72±4.07

FLATTEST MERIDIAN(D)STEEPEST MERIDIAN(D)

Corneal CXL : Pre-op vs Post-op Sim K

Mean pre-op vs post-op Sim K (p>0.05)

Pre and Post CXL Topography

Pre-CXL

Pre-CXL

Post-CXL

Post-CXL

Mean Pre-op and Post-op Mean Spherical Equivalent (MSE) & Cylinder

Baseline POST –CXL P-value

MSE (D) -8.1± 4.5 -7.9± 4.8 P>0.05

MEAN CYLINDER (D)

-4.5 ± 2.3 -5.0± 2.3 P>0.05

0.2

2

UCVA

BCVA

PRE-OP

POST-OP

0.06±0.12

0.72±0.28

0.53±0.38

0.06±0.12

Mean pre-op & post-op UCVA & BCVALo

gMAR

VA

Post-CXL: Complications

• Persistent corneal haze > 3 weeks: Nil• Persistent epithelial defect > 72 hrs: 3

eyes• Sterile infiltrates: Nil• Infective keratitis: Nil• Pre-op vs post-op endothelial cells

(p<0.05)

Conclusions

Cornea Collagen Crosslinking : Safe & effective in stabilizing keratoconus in children