Corneal CXL in Pediatric Keratoconus: Epithelium-off Versus Transepithelial CXL

Friday, April 25, 2014
KIOSKS (Boston Convention and Exhibition Center)
Deniz Ozarslan Ozcan, MD Istanbul, Turkey
Ebru Toker, MD, Marmara University Medical School, Istanbul, Turkey

Narrative Responses:

Purpose
To compare the efficacy and safety of epithelium-off corneal cross-linking (epi-off CXL) and transepithelial cross-linking (TE-CXL) in pediatric patients with progressive keratoconus.

Methods
In this prospective comparative study, 35 eyes of 26 patients with a mean age of 16.4 years (range, 13-18 years) underwent riboflavin- ultraviolet A- induced CXL, either epi-off (n=19) or transepithelial (n=16). Best spectacle-corrected visual acuity (BSCVA), sphere, cyclinder, corneal topography, pachymetry and aberrometry were evaluated at baseline and 1,3,6 and 12 months postoperatively by Scheimflug camera.

Results
In the epi-off CXL group, a significant improvement at month 12 was present for BSCVA (-0.03), K1 (-1.0 D), K2 (-0.9 D), Kmax (-0.9), total RMS (-1.3) and keratoconic indices [ISV(-4.8), IVA(-0.06), KI( -0.02), CKI (-0.02) and IHD(-0.88) ] (p <0.05). In the TE-CXL group, K1, K2, Kmax and keratoconic indices remained stable at the 12 month visit, whereas a significant improvement was present for BSCVA (-0.05, p=0.02). Keratoconus progression (an increase of > 0.75 D in Kmax) was observed in 12.5% in the epi-off CXL group, and 31.2% in the TE-CXL group. No complications were observed in either group.

Conclusion
Both CXL procedures appear to be safe in children. Epi-off CXL has superior efficacy in halting progression of keratoconus.