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Cross-linking may improve vision, minimize aberrations in children with keratoconus
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Corneal cross-linking effectively improved vision and reduced ocular aberrations in children with progressive keratoconus, a study found.
“After an initial worsening of all keratoconus indices, probably because of the epithelial debridement, refractive and topographic outcomes showed a slow but continuous improvement of most of the indices up to 24 months after surgery,” the study authors said.
The prospective, interventional case series included 40 eyes of 40 patients with a mean age of 14.2 years who underwent corneal cross-linking with riboflavin and ultraviolet-A irradiation.
Investigators assessed uncorrected visual acuity, best corrected visual acuity, sphere and cylinder, endothelial cell counts, tomography, aberrometry, and topography at baseline and at 1, 3, 6, 12 and 24 months.
At baseline, mean logMAR UCVA was 0.79 and mean BCVA was 0.39. Mean simulated keratometry was 46.32 D along the flattest meridian and 51.48 D along the steepest meridian.
Study results showed that mean logMAR UCVA was 0.58 and mean BCVA was 0.2 at 2 years; improvements in UCVA and BCVA were statistically significant at all follow-up intervals (P < .05).
Mean simulated keratometry values decreased significantly at 2 years to 45.3 D along the flat meridian (P = .04) and 50.21 D along the steep meridian (P = .07).
Mean spherical equivalent refraction decreased by 1.57 D at 24 months; the change, attributed to reductions of sphere and cylinder, was statistically significant (P = .02).
Corneal aberrations, corneal higher-order aberrations and corneal astigmatism for a 3-mm pupil decreased significantly (P < .05).
Data showed no significant change in endothelial cell counts, the authors said.
Perspective
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William B. Trattler, MD
The paper recently published by Paolo Vinciguerra on 40 eyes of 40 patients 18 years or younger with keratoconus demonstrated that corneal collagen cross-linking was both safe and effective in this population group. Improvements in corneal shape and uncorrected and best corrected vision were demonstrated. In this study, Dr. Vinciguerra waited for patients to demonstrate significant progression of their keratoconus to initiate treatment. I am hopeful that this study further supports the fact that immediately upon diagnosis of keratoconus, patients should be made eligible for cross-linking, rather than waiting to see if there is progression. Waiting in these patients would be the same as waiting for patients with glaucoma to demonstrate visual field loss before initiating treatment. Once keratoconus patients are treated with cross-linking, the patients can expect that they will end up with the same or better visual results in most cases.
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Am J Ophthalmol. 2012;doi: 10.1016/j.ajo.2012.03.020.
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