Posters

Long-term results of accelerated corneal collagen cross-linking for paediatric keratoconus

Poster Details

First Author: L.Fu UK

Co Author(s): F. Carley   A. Brahma   S. Biswas              

Abstract Details

Purpose:

To evaluate the long-term outcomes of accelerated corneal collagen cross-linking in a cohort of paediatric keratoconus patients.

Setting:

A retrospective review of patients aged 18 years and younger attending the paediatric cornea clinic at a tertiary referral centre (Manchester Royal Eye Hospital, UK) from January 2012 to January 2019.

Methods:

A total of 75 paediatric keratoconus patients were identified, of which 42 patients (56%) demonstrated progression suitable for accelerated corneal cross-linking (ACXL). ACXL was performed with standard epithelium-off instillation of 0.1% hypotonic riboflavin solution for 20 minutes (soaking phase) and 9 minutes during the ultraviolet A irradiation (9.5-10mW). Follow-up measurements were compared with baseline values, including best corrected visual acuity (BCVA), pachymetry, corneal haze (densitometry), corneal topography and tomography. Success was defined as either regression (Kmax change <1.0D) or stabilisation (Kmax  ±1.0D); progression and failure was defined as Kmax >1.0D post ACXL.

Results:

54 eyes of 42 patients underwent ACXL. Mean age at presentation was 14.65 years (range 10.6-17.81 years); mean duration of follow-up was 19.2 months (range 6-70 months). Kmax decreased from 56.77±7.30 to 54.53 ± 5.82 (p = <.0.00003) 18 months post ACXL. BCVA improved from 0.51±0.46 to 0.28±0.25 (p = < 0.00001) LogMAR during the same period. 13 eyes had pre-treatment Kmax values greater than 60 dioptres; Kmax decreased from 67.17±5.50 to 61.13±8.64 (p = 0.046) in this subgroup. 12 patients had bilateral cross-linking. There was 1 case of microbial keratitis and 1 repeat cross-linking. Success of ACXL was 83%.

Conclusions:

Accelerated epithelium-off corneal collagen cross-linking is effective for keratoconus in paediatric patients. Treatment of paediatric patients can be initiated once progression is established. Corneal densitometry is a potential objective measure of corneal clarity post cross-linking. Disease asymmetry was evident in this cohort and may have implications for clinical decision-making in paediatric keratoconus.

Financial Disclosure:

None