Corneal CXL in Pediatric Patients
Purpose
Corneal collagen cross-linking (CXL) is well established as a safe, effective procedure in progressive keratoconus in adults. Much less is known about its effects in children. We aim to investigate the safety and efficacy of CXL treatment for keratoconus in a pediatric (aged 18 years or less) population.
Methods
We performed a retrospective analysis of all patients with keratoconus, aged 18 years or younger, who underwent CXL treatment at one centre. We analyzed patient demographics and baseline and follow-up measurements of; uncorrected- and best corrected- visual acuity (UCVA and BCVA), refractive error and Orbscan (Orbtek, Bausch and Lomb,US) corneal topographic values of astigmatism, maximum-, minimum-, and mean- keratometry values (K-max, K-min and K-mean, respectively), and thinnest corneal depth. Follow-up intervals were at 3 months, 6 months and one year for all patients, and at two, three and four years where available.
Results
Twenty-five eyes of 14 patients (11 male, 3 female) were treated between December 2009 and August 2013. Mean age at surgery was 16.2 years (± 1.6). There was no significant difference (p>0.05) between the mean pre-operative and 1-year values of; UCVA; [pre-op: 0.35 (± 0.26)], BCVA; [pre-op; 0.51 (±32)], spherical equivalent; [pre-op; -4.42D (± 3.9)], astigmatism; [pre-op; 3.65D (±4.2)], K-max; [pre-op; 49.62D (±4.5)], K-min; [pre-op; 44.68D (±3.5)] or K-mean; [pre-op; 46.3D (±2.84)]. Mean thinnest pachymetry was significantly reduced from pre-op to 6-months; [473.6µm (±37.68) to 424.55µm (±70.2)], but this recovered at 1-year to 452.82µm (±53.5). There were no post-op infections.
Conclusion
CXL is a safe and effective procedure in pediatric patients with keratoconus. Stable values of visual acuity, refractive error, and keratometry using the Orbscan topographer are demonstrated at 1-year follow-up. There is significant corneal thinning after 6-months, but this shows recovery at one year.