Accelerated Epi-on Versus Standard Epi-off Corneal CXL for Progressive Keratoconus in Pediatric Patients

Sunday, April 19, 2015: 9:05 AM
Room 5B (San Diego Convention Center)
Maria A. Henriquez, MD
Luis Izquierdo Jr, MD
Ana M. Rodriguez, MD

Purpose
To evaluate and compare the effectiveness and safety of accelerate transepithelial (epi-on) corneal collagen crosslinking (CXL) compared to standard CXL (epi-off) in children with progressive keratoconus.

Methods
Prospective, comparative, study included 56 patients younger than 18 years old with progressive keratoconus between November 2013 to December 2014 . Accelerate transepithelial CXL (epi-on) was performed in 34 eyes using 30 minutes of impregnation, 5 minutes of irradiation (18mW), using TE-riboflavin and CCL-VARIO (Peschke Ltd). Standard CXL (epi-on) was performed in 22 eyes using 30 minutes of impregnation, 30 minutes of irradiation (3 mW/cm2), isotonic riboflavin 0.1%/dextran 20% solution and CCL-VARIO (Peschke Ltd). Scheimpflug imaging parameters where evaluated at pre and postoperatively at 1, 6 and 12 months.

Results
Mean maximum keratometry change from 49.52 um to 48.90 um (p = 0.009) in the standard epi-off group and from 49.54 um to 49.33 um in the epi-on group (p = 0.034) at 6 months. Mean uncorrected visual acuity (UCVA) change from 0.62 um to 0.60 (p = 0.06) in the epi-on group and from 0.60  to 0.45 LogMAR in the epi-off group (p = 0.03) at 6 months. There was not statistical significant in terms of  keratometry and posterior elevation values between groups (P>.05) at 6 months postoperatively. There was not complications reported in this group of patients. Results at 12 months will be presented later.

Conclusion
Both accelerate crosslinking epi-on and standard epi-off procedures are safe and efficacy to stop the progression of the keratoconus at 6 months postoperatively. Longer follow up is necessary to confirm these results.