Abstract
Purpose :
In the pediatric population, keratoconus is generally more aggressive, with an increased risk of progression. The aim of the present study was to analyze outcomes of corneal crosslinking (CXL) in pediatric population.
Methods :
Retrospective, observational clinical study. Patients 18 years or younger who had undergone accelerated CXL for keratoconus in 2020 were included. Data collected included demographic characteristics, concomitant allergic conjunctivitis, keratometric values such as Kmin, Kmax, and Kmean, central corneal thickness, corneal thinnest point, and best corrected visual acuity (BCVA) at their initial visit, 1 year and 2 years visit. Progression criteria were defined as two of three of the following: >1D in Kmax, pachymetry ≥ 2% decrease in central corneal thickness, and loss of two visual lines in consecutive measurements. Analysis of variance, t-test, and Fisher’s exact test for statistical analysis was used.
Results :
Fifty-four eyes of 27 patients were included. The mean age was 14.02 ±2 years (range: 9-18). There was a statistically significantly higher proportion (p <0.05) of the 13 to 15 years age group (n= 32 [59.3%]), males (n= 40 [74.1%]), concomitant allergic conjunctivitis (n= 40 [74.1%]), and BCVA better than Snellen 20/50 (n= 34 [63%]). Forty-eight eyes underwent epi-off CXL (88.9%) and six epi-on CXL (11.1%). Baseline keratometric values were: Kmin 48.96 ±5.96 D, Kmax 54.56 ±6.58 D, Kmean 51.58 ±6.2 D, and corneal thinnest point 455 ±48.36 µ.
Forty-seven patients demonstrated statistically significant stability in all keratometric values. On the other hand, seven patients met the progression criteria, four at the 1-year and three at the 2-year follow-up (7.4% and 9.37%, respectively). All of the patients who met the progression criteria had allergic conjunctivitis, and six patients (85.7%) had epi-off CXL (p <0.05). When baseline keratometric values and age were assessed as risk factors for progression, there was no statistically significant difference.
Conclusions :
Pediatric keratoconus can be a difficult challenge to treat; even though allergic conjunctivitis or epi-on CXL could affect the outcomes, accelerated CXL has shown to stabilize keratometric values in all pediatric patients without difference between ages.
This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.