Progression of Keratoconus and Efficacy of Corneal Collagen Cross-linking in Children and Adolescents

Abstract

Original Articles Nico Chatzis, DDS; Farhad Hafezi, MD, PhD To study the progression rate of keratoconus and assess the clinical outcome of corneal collagen cross-linking (CXL) with riboflavin and ultraviolet A light in children and adolescent patients up to 3 years after treatment. Fifty-nine eyes from 42 children and adolescents (aged 9 to 19 years) with confirmed keratoconus were included in this retrospective interventional cohort study. Refraction, slit-lamp examination, Placido-based corneal topography, and Scheimpflug imaging were performed bilaterally in all patients preoperatively and at 6 and 12 months postoperatively. Maximal keratometry readings (Kmax), corrected distance visual acuity (CDVA), corneal thickness, and the keratoconus index (KI) were analyzed. Follow-up was up to 36 months (mean follow-up: 26.3 months [range: 12 to 36 months]). Fifty-two of the 59 eyes enrolled in this study showed progression, corresponding to a progression rate of 88%. Forty-six eyes were treated by CXL. Maximal keratometry, CDVA, and KI showed significant changes over the follow-up period. However, significant Kmax reduction observed up to 24 months after CXL lost significance at 36 months. Cross-linking seems to be safe in children and adolescents. Progression of keratoconus occurred in 88%. We propose that awaiting documentation of progression is not mandatory and CXL in children and adolescents should be performed as soon as the diagnosis has been made. However, the effect of arrest of disease progression might not be as long-lasting as in adults and longer follow-up is needed to verify this trend. From the Department of Ophthalmology, Geneva University Hospitals, Geneva, Switzerland (Chatzis, Hafezi); and the University of Southern California, Doheny Eye Institute, Keck School of Medicine, Department of Ophthalmology, Los Angeles, California (Hafezi). The authors have no financial interest in the materials presented herein. The authors thank Joerg Sommerhalder, PhD, for the statistical analysis of the data. AUTHOR CONTRIBUTIONS Study concept and design (F.H.); data collection (N.C., F.H.); analysis and interpretation of data (N.C., F.H.); drafting of the manuscript (N.C., F.H.); critical revision of the manuscript (N.C., F.H.); administrative, technical, or material support (N.C., F.H.); supervision (F.H.) Correspondence: Farhad Hafezi, MD, PhD, Geneva University Hospitals, Rue Alcide-Jentzer 22, 1211 Geneva, Switzerland. Tel: 41 22 382 83 60; Fax: 41 22 382 84 33; E-mail: farhad.hafezi@unige.ch 10.3928/1081597X-20121011-01 Healio is intended for health care provider use and all comments will be posted at the discretion of the editors. We reserve the right not to post any comments with unsolicited information about medical devices or other products. At no time will Healio be used for medical advice to patients.