Long-term Safety and Efficacy of Corneal Collagen Crosslinking in a Pediatric Group With Progressive Keratoconus: A 7-year Follow-up.

Autor: Polido J; From the Department of Ophthalmology (J.P., M.E.X.A., T.H.K., J.G.A., T.C., R.A., D.F.), Federal University of São Paulo., Araújo MEXDS; From the Department of Ophthalmology (J.P., M.E.X.A., T.H.K., J.G.A., T.C., R.A., D.F.), Federal University of São Paulo; Department of Ophthalmology (M.E.X.A), HSPE/IAMSPE, São Paulo., Wakamatsu TH; From the Department of Ophthalmology (J.P., M.E.X.A., T.H.K., J.G.A., T.C., R.A., D.F.), Federal University of São Paulo., Alexander JG; From the Department of Ophthalmology (J.P., M.E.X.A., T.H.K., J.G.A., T.C., R.A., D.F.), Federal University of São Paulo., Cabral T; From the Department of Ophthalmology (J.P., M.E.X.A., T.H.K., J.G.A., T.C., R.A., D.F.), Federal University of São Paulo; Department of Ophthalmology EBSERH (T.C.), HUCAM/CCS-UFES, Federal University of Espírito Santo, Vitória. Electronic address: thiagogeorge@hotmail.com., Ambrósio R Jr; From the Department of Ophthalmology (J.P., M.E.X.A., T.H.K., J.G.A., T.C., R.A., D.F.), Federal University of São Paulo; and the Department of Ophthalmology (R.A.), Federal University of the State of Rio de Janeiro, Rio de Janeiro, Brazil., Freitas D; From the Department of Ophthalmology (J.P., M.E.X.A., T.H.K., J.G.A., T.C., R.A., D.F.), Federal University of São Paulo.
Jazyk: angličtina
Zdroj: American journal of ophthalmology [Am J Ophthalmol] 2023 Jun; Vol. 250, pp. 59-69. Date of Electronic Publication: 2023 Jan 20.
DOI: 10.1016/j.ajo.2023.01.012
Abstrakt: Purpose: To assess effectiveness and safety of corneal crosslinking (CXL) to reduce keratoconus (KC) progression and improve visual acuity among children with progressive KC and to analyze the use of 20% dextran-based (Dextran) and 1% hydroxypropyl methylcellulose-based (HPMC) riboflavin.
Design: Prospective, clinical cohort study METHODS: Standard CXL (SCXL) was performed in 74 eyes (58 patients, 45 males, mean age 13.0 ± 2.1 years): 53 eyes with HPMC and 21 with Dextran. Examinations were performed at baseline, 3 and 6 months, and 1, 2, 3, 4, 5, and 7 years of follow-up, including uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), a complete ophthalmologic examination, anterior segment ocular coherence tomography, Scheimpflug corneal tomography, and specular microscopy.
Results: UDVA and CDVA improved at all periods with statistically significant differences in CDVA at 1, 2, and 3 years. Compared with baseline, maximum K (Max K) reduced throughout the 7-year follow-up. Mean thinnest pachymetry (Th Pachy) decreased significantly at 3 months and remained low; in the Dextran group, the Th Pachy mean value returned to baseline 6 months postoperatively. After CXL, 1.5 diopter progression in max K was 1.4% to 14.6% of eyes; worsening was found at 4 to 7 years postoperatively.
Conclusion: SCXL reduced KC progression in children up to 7 years of follow-up and revealed improvement and stability of UDVA and CDVA in 82% of eyes. For visual acuity and KC stability, no statistically significant difference was observed between Dextran-HPMC. The HPMC group showed persistent cornea thinning, raising concerns about its use in SCXL.
(Copyright © 2023 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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