Biana Dubinsky-Pertzov1,2, Boris Knyazer3, Adi Einan-Lifshitz4,5, Asaf Achiron2, Shira Hed3, Idan Hecht1,2. 1. Ophthalmology Department, Shamir Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. 2. Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel. 3. Department of Ophthalmology, 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. adi.einan@gmail.com. 5. Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel. adi.einan@gmail.com.
Abstract
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 paediatric populations. METHODS: A historical cohort analysis of paediatric patients (≤18 years) with KC who underwent S-CXL and A-CXL at two tertiary referral centres 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 analysed (A-CXL: n = 39; S-CXL: n = 54). Baseline characteristics were similar between groups. Both groups showed a significant improvement in visual acuity compared to baseline (S-CXL: 0.810-0.602 LogMAR UCVA; A-CXL: 0.890-0.306 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 dioptres following S-CXL (p = 0.02) and by 1.48 ± 8.4 dioptres 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: Paediatric 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.
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 paediatric populations. METHODS: A historical cohort analysis of paediatric patients (≤18 years) with KC who underwent S-CXL and A-CXL at two tertiary referral centres 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 analysed (A-CXL: n = 39; S-CXL: n = 54). Baseline characteristics were similar between groups. Both groups showed a significant improvement in visual acuity compared to baseline (S-CXL: 0.810-0.602 LogMAR UCVA; A-CXL: 0.890-0.306 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 dioptres following S-CXL (p = 0.02) and by 1.48 ± 8.4 dioptres 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: Paediatric 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.
Authors: Daniel A Rosser; Simon N Cousens; Ian E Murdoch; Fred W Fitzke; David A H Laidlaw Journal: Invest Ophthalmol Vis Sci Date: 2003-08 Impact factor: 4.799
Authors: Philipp B Baenninger; Lucas M Bachmann; Ludmilla Wienecke; Michael A Thiel; Claude Kaufmann Journal: Am J Ophthalmol Date: 2017-08-31 Impact factor: 5.258
Authors: Konstantinos D Andreanos; Kate Hashemi; Myrsini Petrelli; Konstantinos Droutsas; Ilias Georgalas; George D Kymionis Journal: Ophthalmol Ther Date: 2017-07-28
Authors: Hala El Rami; Elias Chelala; Ali Dirani; Ali Fadlallah; Henry Fakhoury; Carole Cherfan; George Cherfan; Elias Jarade Journal: Biomed Res Int Date: 2015-09-29 Impact factor: 3.411