ESCRS - FPS10.12 - Three-Year Follow-Up Of Accelerated Versus Standard Corneal Cross-Linking In Pediatric Keratoconus

Three-Year Follow-Up Of Accelerated Versus Standard Corneal Cross-Linking In Pediatric Keratoconus

Published 2022 - 40th Congress of the ESCRS

Reference: FPS10.12 | Type: Free paper | DOI: 10.82333/xyq1-m250

Authors: Boris Knyazer* 1 , Asaf Achiron 2 , Shira Hed 3 , Idan Hecht 4 , Biana Dubinsky-Pertzov 4 , Adi Einan-Lifshitz 4

1​Ophthalmology Department,​Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev,Beer-Sheva,Israel, 2​Ophthalmology Department,Sackler School of Medicine, Tel Aviv University,Tel Aviv,Israel, 3​Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev,Beer-Sheva,Israel, 4​Ophthalmology Department,Shamir medical center, Sackler Faculty of Medicine, Tel-Aviv University,Tel Aviv,Israel

Purpose

Standard corneal collagen cross-linking (S-CXL) is an effective treatment to arrest Keratoconus (KC) progression in children. Less is known on the long-term efficacy of accelerated CXL (A-CXL) in pediatric populations.

Setting

The retrospectively reviewed a pediatric patients' files with progressive KC who underwent S-CXL and A-CXL at Shamir Medical Center and Soroka University Medical Center in Israel between 2010-2017.

Methods

A historical cohort analysis of pediatric patients (≤ 18 years) with KC who underwent S-CXL and A-CXL at two tertiary referral centers in Israel between 2010-2017. Preoperative and 3-year postoperative evaluation included changes in visual acuity (best spectacle corrected [BSCVA]) and uncorrected [UCVA]), refractive errors, and keratometric data.

Results

Ninety-three eyes of 93 patients were analyzed (A-CXL: n=39; S-CXL: n=54). Baseline characteristics were similar between groups. Both groups showed a significant improvement in visual acuity compare to baseline (S-CXL: 0.810 to 0.602 LogMAR UCVA; A-CXL: 0.890 to 0.306 LogMAR UCVA, p<0.05 for both). Improvement in BSCVA and UCVA following A-CXL was non-inferior to S-CXL (< ±0.2 LogMAR). Kmax decreased by a mean of 0.98±5.56 diopters following S-CXL (p=0.02) and by 1.48±8.4 diopters following A-CXL (p=0.015). Thinnest pachymetry decreased following both treatments (S-CXL: by 26.8±40.7 µm, p=0.001, A-CXL: by 10.2±13.4 µm, p=0.028), the difference between groups was within the non-inferiority margin (< ±10 µm). 

Conclusions

Pediatric patients followed for three years after A-CXL showed improved visual function, reduced corneal astigmatism and Kmax, and decreased thinnest corneal thickness. A-CXL was non-inferior to S-CXL at three years in terms of best-corrected and uncorrected visual acuity, thinnest pachymetry, and astigmatism. For Kmax, non-inferiority could not be concluded.