Collagen crosslinking provides corneal stability in young patients

Reviewed by Dr Solin Saleh.

Corneal collagen crosslinking (CXL) in paediatric and young adult patients with keratoconus can stabilise, and in some cases even improve, corneal keratometry and vision up to 2 years postoperatively, according to study results presented by Dr Solin Saleh. Dr Saleh, who recently completed her paediatric ophthalmology fellowship at the Byers Eye Institute at Stanford University School of Medicine in California, United States, reported the findings at the American Society of Cataract and Refractive Surgery (ASCRS) 2021 annual meeting in July.

The study was designed by Dr Edward E. Manche, director of cornea and refractive surgery and Stanford University professor of ophthalmology. It consisted of a retrospective chart review of patients 22 years or younger who had undergone CXL for progressive keratoconus at the Byers Eye Institute during the previous 7 years. All CXL procedures were performed by Dr Manche.

Dr Solin Saleh

The investigators evaluated the patient records to identify changes in visual and corneal parameters, including corrected distance visual acuity (CDVA) and maximum keratometry (Kmax) up to 2 years after CXL. Dr Saleh explained that the findings are important because although keratoconus is generally diagnosed during puberty, it can be more severe and progress more quickly when identified in younger children, who may need corneal transplantation if the disease is not addressed.

Findings

Dr Saleh reported that 86 eyes of 71 consecutive patients underwent CXL during the study period. The patients ranged in age from 12 to 22 years (mean 16.4 ± 2.5 years) at the time of surgery. Bilateral CXL was performed in eight patients. Of the study sample, 57 eyes had completed a minimum of 1 year of follow-up and 24 eyes had completed 2 years of follow-up.

Dr Saleh reported that the mean preoperative CDVA was logMAR 0.38 ± 0.32 (Snellen acuity 20/48), with mean postoperative CDVA of 0.29 ± 0.31 (20/39) and 0.31 ± 0.31 (20/41) at 12 and 24 months postoperatively. Compared with preoperative mean Kmax, there was an improvement of –0.8 D to a mean postoperative Kmax of 59.1 ± 9.1 D at 12 months and –1.3 D to 59.7 ± 8.8 D at 24 months.

The authors concluded that CXL was both safe and effective to perform in this young patient population. The procedure stabilised the cornea in these children and young adults, and in some cases the vision and the keratometry values improved. The authors urged surgeons to consider CXL for treating paediatric patients with early keratoconus to prevent ongoing disease progression, especially given the risk of visual morbidity in children.

Solin Saleh, MD

E: solsaleh@stanford.edu

This article is adapted from Dr Saleh’s presentation at the American Society of Cataract and Refractive Surgery annual meeting. She has no financial interest in this subject matter.

Edward E. Manche, MD

E: cornea@stanford.edu

Dr Manche has no financial disclosures related to this content.

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