Standard cross-linking protocol versus accelerated and transepithelial cross-linking protocols for treatment of paediatric keratoconus: a 2-year comparative study.
Administration, Ophthalmic
Adolescent
Child
Corneal Topography
Cross-Linking Reagents
/ therapeutic use
Disease Progression
Epithelium, Corneal
/ drug effects
Female
Humans
Keratoconus
/ classification
Male
Photosensitizing Agents
/ therapeutic use
Riboflavin
/ administration & dosage
Ultraviolet Therapy
/ methods
Visual Acuity
/ drug effects
accelerated CXL
keratoconus progression
paediatric keratoconus
standard cross-linking
transepithelial CXL
vernal keratoconjunctivitis
Journal
Acta ophthalmologica
ISSN: 1755-3768
Titre abrégé: Acta Ophthalmol
Pays: England
ID NLM: 101468102
Informations de publication
Date de publication:
May 2020
May 2020
Historique:
received:
08
05
2019
accepted:
18
09
2019
pubmed:
28
10
2019
medline:
10
2
2021
entrez:
27
10
2019
Statut:
ppublish
Résumé
To compare the efficacy, safety and stability of standard epithelium-off cross-linking (SCXL) versus accelerated epithelium-off cross-linking (ACXL) and transepithelial epithelium-on cross-linking (TCXL) in the treatment of progressive keratoconus (KC) in children. This prospective multicentre controlled trial included 271 eyes (136 children) with grade 1-3 progressive KC who were randomized to undergo SCXL (n = 91, as a control group), ACXL (n = 92) or TCXL (n = 88). Uncorrected and corrected distance visual acuity, subjective refraction, pachymetry, keratometry and corneal topography measurements were recorded preoperatively and 6, 12 and 24 months postoperatively. At 1 year, there was no significant difference in uncorrected distance visual acuity, refractive sphere, cylinder, spherical equivalent or Kmax between the ACXL and SCXL groups; however, during year 2, ACXL regressed while SCXL continued to improve. After 2 years, there were significant differences in all visual, refractive and keratometric components between SCXL and both ACXL and TCXL (p < 0.0001) and between ACXL and TCXL (p < 0.0001). KC progressed in 5.4% of patients who had ACXL and 28.4% of those who had TCXL but in none of those who had SCXL. Vernal keratoconjunctivitis was documented in 43.3% of eyes that progressed postoperatively. SCXL was more effective for paediatric KC and achieved greater stability than either ACXL or TCXL, and ACXL was superior to TCXL. SCXL also achieved marked improvement in both myopia and spherical equivalent; however, these refractive outcomes were unpredictable and uncontrollable. TCXL had a 28.4% failure rate within 2 years. SCXL is preferable for management of paediatric KC.
Identifiants
pubmed: 31654497
doi: 10.1111/aos.14275
pmc: PMC7216930
doi:
Substances chimiques
Cross-Linking Reagents
0
Photosensitizing Agents
0
Riboflavin
TLM2976OFR
Types de publication
Comparative Study
Journal Article
Multicenter Study
Randomized Controlled Trial
Langues
eng
Sous-ensembles de citation
IM
Pagination
e352-e362Informations de copyright
© 2019 The Authors. Acta Ophthalmologica published by John Wiley & Sons Ltd on behalf of Acta Ophthalmologica Scandinavica Foundation.
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