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Juan Carlos Carlos Abad, Juan Camilo Morales, Alexandra Correa, Renato Ambrosio, Michael W Belin; Do we have to cross-link all children with keratoconus?. Invest. Ophthalmol. Vis. Sci. 2018;59(9):4388. doi: https://doi.org/.
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There is a generalized belief that all children with keratoconus should be offered corneal cross-linking (CXL) as soon as the diagnosis is made. Despite being a highly effective procedure, CXL is not without complications. We postulated that strict control of eye rubbing could be used as a first-line therapy. Careful follow up with manifest refractions and serial Pentacams (Oculus Gmbh, Wetzlar, Germany) was done. Only those cases demonstrating progression were subject to CXL.
Twenty-four patients (13 male, 11 female) 18 years and under seen at a keratoconus referral clinic from 2012 to 2017 who had at least one eye with a BAD D greater than 1.42 on the Belin-Ambrosio display on the Pentacam were included. Four patients who had immediate CXL were excluded from further analysis. Eye-rubbing avoidance was recommended along with topical anti-histamines. A follow-up Pentacam was schedulled in 3 to 6 months. The Belin ABCD progression display was retrospectively analyzed on all of them. Additional variables such as Kmax, ARTmax, BAD "D", were analyzed. At the beginning of the study criteria for progression (two out of four) was decrease in corneal thickness, and anterior or posterior radius of curvature, or an increase in Kmax. Upon implementation in 2017 the ABCD progression display was used to detect progession. Cases deemed progressive were submitted to CXL using riboflavin and UVA 9 mW/cm2 for 7-10 minutes. No eye lost more than two lines of BCVA on follow up.
Out of those 20 patients (forty eyes) included, four patients (8 eyes) (25%) were deemed progressive and submitted to CXL. The rest of the patients have remained stable thru follow-up. The B value (posterior radius of curvature at thinnest point 3.0 mm OZ) of the ABCD progression display and the BAD "D" seemed to be the most sensible parameters to detect progression. Corneal thickness showed greater variability than the other tested parameters.
Control of corneal rubbing combined with careful follow-up and selective CXL seems to be a viable alternative in the management of children with keratoconus. It does not seem to be necessary to perform CXL in all children presenting with possible keratoconus. The ABCD progession display along with the BAD "D" value seem to be effective parameters to detect progression in children with keratoconus.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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