Abstract
Purpose :
To report the 3 year follow-up clinical characteristics, visual and topographic outcomes of pulsed-light accelerated crosslinking (A-CXL) protocol in a northeastern Mexican pediatric population with progressive keratoconus
Methods :
Retrospective case series study of pediatric patients with keratoconus in whom crosslinking was performed between January 2016 and December 2020. Inclusion criteria comprised patients aged 18 or under with progressive keratoconus treated with epi-off pulsed-light A-CXL protocol (30mW/cm2 x 8 min, total energy dose of 7.2J/cm2). Medical history, BCVA, slit lamp examination, endothelial cell count (ECC), spherical equivalent (SE) and Scheimpflug corneal tomography previous and after crosslinking were analyzed. Statistical analysis was performed using the paired t-test with the STATA software
Results :
A total of 28 eyes of 17 patients, 15 (88.2%) males and 2 (11.8%) females were included. Mean follow-up time was 646±411 days since the diagnosis of keratoconus. Mean Body Mass Index was 25.7± 9.5 (overweight). Allergic conjunctivitis was present in 65% of patients, and 47% of patients reported rubbing their eyes. Mean age at surgery was 13.8±2.72 years (range, 9-18). Mean BCVA was 0.64±0.59 logMAR at baseline and 0.34±0.32 logMAR at the last follow up (p=0.0019). Baseline SE was -3.88 and -4.12 at the last follow up, refractive cylinder values were -3.72 at baseline and –4.38 at the last follow up. Mean baseline K1, K2, and Km values were 47.54 D, 54.97 D, and 50.71 D, respectively; at the last time follow up these values decreased to 47.37 D (p=0.62), 54.56 D (p=0.42) and 50.65 D (p=0.58) respectively. Preoperative central and thinnest pachymetry by Pentacam were 475.48 um and 460.77 um respectively, compared to post-operative values of 470.00 um (p=0.90) and 456.63 um (p=0.80). The most common topographic pattern was inferotemporal steepening 32.1%, ECC decreased from a mean preoperative value of 2903 cells to 2886 cells (p=0.81). Two eyes developed infectious keratitis after the procedure, and 1 eye had hydrops after crosslinking
Conclusions :
There seems to be an association between allergic conjunctivitis, overweight patients and keratoconus progression in these patients. A-CXL seems to be safe and effective to halt progression in this population with improvement of BCVA. Further follow up is necessary to measure long-term effects
This is a 2021 ARVO Annual Meeting abstract.