Case Reports

Accelerated contact lens-assisted corneal collagen cross-linking and piggyback modification in a paediatric case with advanced keratoconus and thin cornea

Case Report Details

First Author: I.Toprak SPAIN

Co Author(s):                        

Abstract Details

Purpose:

To present outcomes of accelerated contact lens-assisted corneal crosslinking (CACXL) and piggyback modification in a paediatric case with advanced keratoconus (KC) and thin cornea.

Setting:

Pamukkale University, Denizli, Turkey

Report of Case:

A 14-years-old female was diagnosed as bilateral stage-3 KC (Amsler-Krumeich classification). Maximum keratometry (Kmax) was 63.9 D OD and 63.7 D OS. Minimum corneal thickness (MCT) was 371 microns OD and 370 microns OS. Right eye underwent epithelium-off accelerated-CACXL (9 mW/cm2 for 10 minutes of UVA) using hypo-tonic dextran-free 0.1% riboflavin solution and a riboflavin-soaked UV barrier-free soft contact lens made of balafilcon A (70-microns thick), to increase functional thickness over 400 microns. Same procedure was followed for the left eye 4-months later, whereas two riboflavin-soaked soft contact lenses were applied in piggyback fashion instead to ensure safety. At 19-months, in the right eye, visual acuity (+0.2 Snellen), Kmax (-2.4 D), mean K (-2.6 D) and topographical indices were improved. In the left eye, visual acuity (+0.2 Snellen), mean K (-1.1 D) and central KC index were improved. No complication was detected during follow-up.

Conclusion/Take Home Message:

Accelerated standard- and piggyback- CACXL appear to be safe and effective treatment options in paediatric patients with KC and thin cornea, in which KC is more aggressive and prompt treatment is critical. However, piggyback contact lens modification might slightly reduce the CACXL efficacy.

Financial Disclosure:

None