Clinical Ophthalmology (Nov 2020)

Long-Term Visual, Refractive and Topographic Outcomes of “Epi-off” Corneal Collagen Cross-Linking in Pediatric Keratoconus: Standard versus Accelerated Protocol

  • Amer I,
  • Elaskary A,
  • Mostafa A,
  • Hazem HA,
  • Omar A,
  • Abdou A

Journal volume & issue
Vol. Volume 14
pp. 3747 – 3754

Abstract

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Ibrahim Amer,1 Abdelhakeem Elaskary,1 Ali Mostafa,2 Hazem A Hazem,2 Ahmed Omar,2,3 Ahmed Abdou2 1Ophthalmology Department, Faculty of Medicine, AL-Azhar University, Assiut, Egypt; 2Ophthalmology Department, Faculty of Medicine, Assiut University, Assiut, Egypt; 3University Hospitals Eye Institute and the Department of Ophthalmology and Visual Sciences, Case Western Reserve University School of Medicine, Cleveland, Ohio, USACorrespondence: Ahmed AbdouOphthalmology Department, Faculty of Medicine, Assiut University, Assiut 71515, EgyptTel +201004343388Email [email protected]: To compare the visual, refractive and topographic outcomes of standard and accelerated corneal collagen cross-linking (CXL) in pediatric keratoconus patients.Methods: Prospective, comparative observational study on 68 eyes of 35 pediatric keratoconus patients (< 18 years). Patients were classified into two groups, group (I) included 34 eyes and received standard “Epi-Off” CXL (3 mW/cm2, 30 min.) and group (II) included 34 eyes and received accelerated “Epi-Off” CXL (9 mW/cm2, 10 min.). Uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), spherical equivalent (SE), simulated keratometry (Sim K-1, Sim K-2, K-max, K-mean), cylindrical (CYL), pachymetry and Q-value were evaluated preoperatively and for 3 years postoperatively.Results: Postoperative UDVA and CDVA did not significantly change in both groups after 3 years. Postoperative SE was increased significantly in accelerated CXL (p=0.012) with no significant change in the postoperative cylinder in both procedures. Standard CXL had greater “significant” effect in decreasing Sim K-1, K-max and K-mean. The mean reduction in postoperative corneal pachymetry (at thinnest location) was significant in standard CXL (18.4 μm) (p=0.001). No significant change was noticed in postoperative Q-value.Conclusion: Standard and accelerated CXL protocols are efficient in pediatric keratoconus management with better outcomes in the standard procedure.Keywords: standard CXL, accelerated CXL, corneal collagen cross-linking, pediatric keratoconus

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