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