Transcript Corneal Cross-linking Results in Children with Progressive

Corneal CXL in Children With
Progessive Keratoconus
Authors
• Ashok Sharma, Cornea Centre, Chandigarh, India
• Verinder S Nirankari, Eye Consultants of Maryland
Author do not have any financial interest in the surgical
procedure or the medicines used in this study
Purpose
To present visual, refractive and
topographic outcome after corneal
cross-linking (CXL) for progressive
keratoconus in children below 18
years
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
Corneal CXL : Pre-op vs Post-op Sim K
51
FLATTEST MERIDIAN(D)
STEEPEST MERIDIAN(D)
50
50.5
±4.38
49
49.72
±4.07
48
47
47.96
±3.40
46
46.95
±4.07
45
PRE-OP
POST-OP
Mean pre-op vs post-op Sim K (p>0.05)
Pre and Post CXL Topography
Post-CXL
Pre-CXL
Pre-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
Mean pre-op & post-op UCVA & BCVA
0.05
UCVA
LogMAR VA
BCVA
0.06
±0.12
0.06
±0.12
0.5
0.53
±0.38
0.72
±0.28
PRE-OP
POST-OP
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