Epi-off Corneal Crosslinking Effectively Stabilizes Pediatric Keratoconus

Child with eye doctor
Medical treatment with autorefractokeratotonometer.
The study also demonstrated that the new Belin ABCD staging software is an effective tool for monitoring patients after CXL.

This article is part of Optometry Advisor’s conference coverage from the 2021 meeting of the American Academy of Optometry, held in Boston from November 3 to 6, 2021. The team at Optometry Advisor will be reporting on a variety of the research presented by the primary eye care experts at the AAO. Check back for more from the AAO Optometry 2021 Meeting..

Epithelium-off (epi-off) corneal collagen crosslinking (CXL) treatments can effectively stabilize pediatric keratoconus patients, according to findings presented at the American Academy of Optometry 2021 annual meeting, held in Boston from November 3-6. The study also demonstrated the clinical utilization of a staging software for postoperative monitoring of these patients.

Researchers conducted the retrospective study to evaluate the effects and outcomes of CXL on the progression of pediatric keratoconus wherein it reviewed the charts of pediatric patients who received the FDA-approved epithelium-off CXL treatments for progressive keratoconus. From April 2016 to March 2021, all patients underwent CXL at the Wills Eye Hospital in Philadelphia, PA. The study analyzed the demographic data, keratometric readings, Belin ABCD keratoconus staging system data, and Zernicke coefficients for higher aberrations at pre-CXL, 6-month, and 1-year follow up.

The study included 34 eyes of 24 patients and found that, at 6 months, there was a decrease in mean maximum keratometry (Kmax, P =.048), anterior radius of curvature (A value, P =.011), and thinnest pachymetry (P <.001), while an increase was seen in posterior radius of curvature (B value, P =.003) and spherical aberration coefficient (P <.001). There was a decrease in mean corneal astigmatism at 6 and 12 months, but it was not statistically significant. However, there was a significant increase in spherical aberration at 12 months (P <.001). 

An additional finding of interest was an increase in mean B value from the Belin ABCD staging system; however, there was no evidence of progression from conventional metrics such as Kmax.

“Thus, FDA-approved epi-off CXL can effectively stabilize pediatric keratoconus patients, but a longer follow-up will be needed to assess long-term outcomes in the United States,” the study explained.

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Yu J, Chang C, Meghpara B, Syed Z Capuano C. Corneal collagen cross-linking outcomes in pediatric keratoconus patients in the United States. Poster presented at: American Academy of Optometry 2021 annual meeting; November 3-6; Boston. Board #20