AUTHOR=Wajnsztajn Denise , Shmueli Or , Tarnovsky Yehuda , Frucht-Pery Joseph , Solomon Abraham 

TITLE=Outcome indicators for cross linking in pediatric keratoconus

JOURNAL=Frontiers in Medicine

VOLUME=10

YEAR=2023

URL=https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2023.1149641

DOI=10.3389/fmed.2023.1149641

ISSN=2296-858X

ABSTRACT=<sec><title>Purpose</title><p>To evaluate the predictive factors for successful corneal collagen cross-linking (CXL) in pediatric patients with Keratoconus (KC).</p></sec><sec><title>Methods</title><p>This retrospective study was conducted using a prospectively built database. Patients (18 years old or younger) underwent CXL for KC between 2007 and 2017, with a 1-year follow-up period or longer. The outcomes included changes in Kmax (delta [Δ] Kmax = Kmax<sub>last</sub> − Kmax<sub>pre</sub>) and LogMAR visual acuity (ΔLogMAR = LogMAR<sub>last</sub> − LogMAR<sub>pre</sub>).</p><p>The effects of CXL type (accelerated or non-accelerated), demographics (age, sex, background of ocular allergy, ethnicity), preoperative LogMAR visual acuity, maximal corneal power (Kmax), pachymetry (CCT<sub>pre</sub>), refractive cylinder, and follow-up (FU) time on the outcomes were analyzed.</p></sec><sec><title>Results</title><p>One hundred thirty-one eyes of 110 children were included (mean age, 16 ± 2 years; range, 10–18 years). Kmax and LogMAR improved from baseline to last visit: from 53.81 D ± 6.39 D to 52.31 D ± 6.06 D (<italic>p</italic> &lt; 0.001) and from 0.27 ± 0.23 LogMAR units to 0.23 ± 0.19 LogMAR units (<italic>p</italic> = 0.005), respectively. A negative ΔKmax (meaning corneal flattening) was associated with a long FU, low CCT<sub>pre</sub>, high Kmax<sub>pre</sub>, high LogMAR<sub>pre,</sub> and non-accelerated CXL on univariate analysis. High Kmax<sub>pre</sub> and non-accelerated CXL were associated with negative ΔKmax in the multivariate analysis.</p><p>A negative ΔLogMAR (meaning vision improvement) was associated with a high LogMAR<sub>pre</sub> in univariate analysis.</p></sec><sec><title>Conclusion</title><p>CXL is an effective treatment option in pediatric patients with KC. Our results showed that the non-accelerated treatment was more effective than the accelerated treatment. Corneas with advanced disease had a greater effect on CXL.</p></sec>