Emerging experience supports use of CXL in children

Cornea specialists performing corneal collagen crosslinking (CXL) with the standard Dresden protocol are finding it to be safe and effective for stabilising progressive keratoconus in children.

Harshavardhan Reddy, MD, and Ashok Sharma, MD, summarised their experience using CXL to treat keratoconus in paediatric eyes during a free paper session on corneal surgery at the 26th Asia-Pacific Association of Cataract & Refractive Surgeons Annual Meeting.

Dr. Reddy's report included 14 eyes of 10 patients (mean age 14.1 years) treated at Maxivision Eye Hospitals, Hyderabad, India. The procedures were done between June, 2011, and June, 2012. 

At six months post-treatment, no eyes showed evidence of keratoconus progression, keratometry was decreased from baseline by 1.5 D, and BSCVA was improved in the majority of eyes. Notably, the effects of CXL on keratometry and BSCVA were better in the paediatric series than in a comparator group comprised of 12 older patients (13 eyes, mean age 20.4 years) treated during the same time period. 

"Our experience with CXL to treat progressive keratoconus in Asian paediatric eyes shows changes in keratometry and BSCVA similar to what has been reported in published studies from European centers," said Dr. Reddy.

"Based on our findings, we believe age younger than 18 years represents an indication for early CXL as it appears these patients might achieve greater improvement in vision and flattening of the cornea than older individuals."

Dr. Sharma's series included 32 eyes treated at the Cornea Centre, Chandigarh, India. After a mean follow-up of 26 months, corneal topography was stable in 91% of eyes, and there were no significant changes from baseline in mean spherical equivalent, mean cylinder, mean UCVA, or mean BSCVA. Safety was good in both series.

"We had no significant complications," said Dr. Sharma. "Although corneal oedema after CXL has been reported by others, we did not observe any corneal oedema in this series."