Content area
Full Text
Keratoconus progression is frequent and faster in children when the age at the time of diagnosis is younger than 18 years.1--3 Corneal transplant may be required at an early age for cases with advanced keratoconus with or without scarring. In children, graft failure rates are higher and visual prognosis is poor with penetrating keratoplasty.4,5
Corneal collagen cross-linking (CXL) is a promising treatment modality for keratoconus, as it is the only intervention that can potentially slow down the progression of the disease.6 In this procedure, riboflavin (vitamin B2) is administered in conjunction with ultraviolet A (UVA, 365 nm). The interaction of riboflavin and UVA causes the formation of reactive oxygen species, leading to the formation of additional covalent bonds between collagen molecules, with consequent biomechanical stiffening of the cornea. 7
Recently, studies by Caporossi et al1,2 and Vinciguerra et al8 have reported good clinical results concerning safety and efficacy of epithelium-off CXL treatment in patients aged 18 years or younger. In this study, we analyzed primary visual acuity and refractive and topographic outcomes in 15 eyes from 15 children with keratoconus with advanced disease in the fellow eye.
Patients and Methods
Fifteen eyes from 15 children aged 15 years or younger (range: 10 to 15 years) were enrolled in the study from September 2009 to March 2011. Inclusion criteria were patients with stage I or II keratoconus (Amsler Krumeich classification)9 and advanced disease in the fellow eye at presentation, corneal thickness at the thinnest point 400 μm, and maximum corneal curvature 53.00 diopters (D). Only one eye of each patient underwent CXL. Six patients had been previously managed for corneal hydrops in fellow eyes, 3 patients underwent deep anterior lamellar keratoplasty, and 6 patients were awaiting corneal transplant for advanced keratoconus in the worse fellow eye. Progression of keratoconus was not an inclusion criterion for CXL.
Exclusion criteria were corneal thickness <400 μm at the thinnest point, severe vernal keratoconjunctivitis, severe dry eye, history of herpetic keratitis, concurrent autoimmune diseases, previous ocular surgeries, and central or paracentral opacities. All patients (n=9) with mild to moderate vernal keratoconjunctivitis were controlled prior to the procedure. All patients underwent uncorrected (UDVA) and corrected (CDVA) distance visual acuity assessment, slit-lamp microscopy, basal Schirmer...