corneal cxl in children with progessive keratoconus author do not have any financial interest in the...

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