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Maurizio G Uva, Antonio Longo, Carlo Rapisarsa, Angela Cantavenera, Matteo Fallico, Michele Reibaldi, Erika Bonacci, Teresio Avitabile; Efficacy of trans-epithelial cross-linking for treatment of progressive keratoconus in paediatric age. Invest. Ophthalmol. Vis. Sci. 2014;55(13):6289.
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To evaluate the visual and corneal tomographic effects of trans-epithelial cross-linking (TE-CXL) in paediatric patients with progressive keratoconus (KC).
In a prospective study were enrolled all consecutive patients affected with progressive KC (progression: change of at least 1.5 D of mean central K reading observed in 2 consecutive topographies), aging less than 18 years, treated with TE-CXL. TE-CXL was performed in topical anaesthesia: a silicone ring was positioned on the cornea, and it was filled with a 0.1% riboflavin-15% dextran solution (Ricrolin TE; Sooft, Italy) and maintained on the cornea for 30 minutes (imbibition phase). then, after the ring removal, the irradiation was performed by using an UVA source (CBM X-linker Vega; Costruzione Strumenti Oftalmici, Florence, Italy) in the central 8-9 mm of the cornea; irradiation was performed at 3 mW/cm2 for 6 steps of 5 minutes each (total 30 minutes); at completion of every step, several drops of riboflavine were instilled. Visual acuity, refraction, and corneal tomographic parameters as assessed by Orbscan II were evaluated at baseline and after 1 year. KC progression was considered an increase in mean K of at least 1.5 D. in each group, values before treatment and 1 year after treatment were compared by paired t-test.
Were treated with TE-CXL 18 patients (age 10-17 years); corneal thickness at thinnest point was <450 microns in 8 eyes (mean 431±16 microns), and >450 microns in 10 eyes (mean 489±15 microns). After 1 year, in eyes with thinnest<450, we found no changes in visual acuity and refraction, but a significant increase of highest posterior elevation on best-fit sphere (BFS) (122±34 microns vs. 147±27 microns, p=0.009), SimK max (52.9±2.2 D vs. 55.7±3.3 D, p=0.013) and SimK min (46±1.8 D vs. 47.9±1.9 D, p=0.024), and a reduction of corneal thickness at thinnest point (431±16 microns vs. 418±11 microns, p=0.037). A KC progression was found in 6 of 8 eyes. Among the eyes with thinnest > 450 microns, were seen unchanged visual acuity and reduction of refractive cylinder; no eye had a KC progression.
TE-CXL stabilizes keratoconus in eyes with corneal thinnest >450 microns, while more than 50% of eyes with corneal thinnest <450 microns had progression of tomographic parameters: this indicates the importance of an early diagnosis and treatment.
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