Posters

Transepithelial iontophoresis corneal collagen cross-linking in paediatric progressive keratoconus: 24 months of follow-up

Poster Details

First Author: E. Chiariello Vecchio ITALY

Co Author(s):    S. Troisi   F. Di Landro   M. Troisi   A. Magli   A. Greco        

Abstract Details

Purpose:

Our purpose was to evaluate functional and anatomical outcomes of transepithelial iontophoresis corneal collagen cross-linking (I-CXL) in pediatric patients with progressive keratoconus.

Setting:

Eye Ophthalmology Department AOU “San Giovanni di Dio e Ruggi d’Aragona”, Via San Leonardo,1 Salerno, Italy

Methods:

26 patients (26 eyes) diagnosed with progressive keratoconus underwent corneal CXL with iontophoresis (I-CXL) at the Eye Department “San Giovanni di Dio e Ruggi D’Aragona hospital” of Salerno, from December 2013 to December 2015 were enrolled. Preoperative and postoperative visits at 1, 6, 12, 18 and 24 months assessed the following parameters: uncorrected visual acuity, best-corrected visual acuity, slit-lamp biomicroscopy, corneal topography, optical tomography and pachymetry with Pentacam (Oculus Optikgeräte GmbH, Wetzlar, Germany), endothelial biomicroscopy (Konan Specular Microscope; Konan Medical, Inc., Hyogo, Japan). The stage of keratoconus was classified according to the modified Amsler-Muckenhirn classification provided by Pentacam

Results:

20 males and 6 females with a mean age of 16.4 ± 1.7 years (range 11-18 years) were included. No patient was lost to follow-up. The results showed a stabilization of the refractive UCVA and BCVA as early as the first post-operative month, with a slight improvement over time (p< 0.04). The Kmax remained stable throughout follow-up (p =0.05), whereas a significant improvement at month 24 was present for index of surface variance (p= 0.04) and keratoconus index (p= 0.02). Topometric values showed a stabilization of the clinical picture during follow-up. The average count of endothelial cells didn’t change significantly

Conclusions:

Classic CXL is well-validated and standardized, efficacy proven, but it involves a series of side effects and discomfort. Sparing the corneal epithelium makes the surgery safer and more tolerable, allows to respect the corneal cytoarchitecture and to spare the nerve fibers responsible for pain, reducing corneal inflammation responsible for complications. Results of this study are very encouraging and promising and indicate I-CXL as a viable alternative to the traditional technique in the treatment of evolutive keratoconus in a pediatric age group. Further studies are needed to evaluate the long-term safety and efficacy compared to standard CXL.

Financial Disclosure:

NONE