Abstract
Purpose :
To evaluate the results of corneal collagen cross-linking (CXL) in developmentally delayed and pediatric patients with keratoconus (KCN) under both general and topical anesthesia.
Methods :
Data of individuals with KCN who underwent CXL under both general anesthesia as well as topical anesthesia were analyzed retrospectively by examining patient charts. This study is comprised of individuals who had CXL between January 2019 and November 2020. Differences between patients with and without developmental delay (DD) as well as changes in disease characteristics before and after surgeries were compared using the Pearson χ2 and t-test.
Results :
This study tracked 35 eyes of 22 patients with a mean follow-up of 7.2 ± 6.2 months. Of these 22 patients, 9 (40.9%) had DD. Patients with DD underwent CXL at an older age compared to patients without DD (mean age: 22.1 years vs 17.8 years), although this difference was not statistically significant. The nine DD patients were administered general anesthesia, and the remaining 13 patients without DD were given topical anesthesia. Regarding preoperative characteristics, patients with DD had a BCVA in LogMAR of 0.829 vs. 0.325 (p = 0.005). Corneal thickness (CT), sphere, cylinder, K1, K2, and Km were not significantly different between the two groups. Postoperatively, BCVA in LogMAR for patients with DD was 0.739 and 0.222 in non-developmentally delayed (p = 0.012). Sphere, cylinder, K1, K2, Km, and CT were not significantly different between the two groups.
There was no significant postoperative change in BCVA, K1, K2, Km, sphere, cylinder, and CT compared to preoperative for the entire cohort of patients. No complications were observed during the procedures. Two patients needed retreatment at 1 and 11 months after initial crosslinking.
Conclusions :
CXL under general anesthesia for developmentally delayed patients gives equivalent outcomes in halting progression of topographic parameters as compared to CXL under topical anesthesia for non-developmentally delayed patients. Pre and postoperative BCVA was not equivalent between the groups because of the inability of patients with DD to wear glasses or contact lenses. Early intervention should be considered in DD so that vision can be preserved to the greatest degree possible.
This is a 2021 ARVO Annual Meeting abstract.