Progression of Keratoconus and Efficacy of Pediatric Corneal Collagen Cross-linking in Children and Adolescents
Progression of Keratoconus and Efficacy of Pediatric Corneal Collagen Cross-linking in Children and Adolescents
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DOI：
10.3928/1081597x-20121011-01
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发表时间：
2012-11-01
影响因子：
2.4
通讯作者：
Hafezi, Farhad
中科院分区：
文献类型：
--
作者：
Chatzis, Nico;Hafezi, Farhad
目得：研究圆锥角膜的进展率，并评估角膜胶原交联（CXL）与核黄素和紫外线A光在儿童和青少年患者治疗后3年的临床结局。方法：从42名儿童和青少年（9至19岁）确诊圆锥角膜的59只眼睛被纳入这项回顾性干预性队列研究。所有患者在术前和术后6个月和12个月进行双侧屈光检查、裂隙灯检查、基于Placido的角膜地形图和Scheimpflug成像。分析最大角膜曲率读数（Kmax）、矫正远视力（CDVA）、角膜厚度和圆锥角膜指数（KI）。随访时间为36个月（平均随访时间：26.3个月[范围：12至36个月]）。结果：本研究纳入的59只眼中有52只出现进展，相应的进展率为88%。CXL治疗46眼。最大角膜曲率、CDVA和KI在随访期间显示出显著变化。然而，显着的Kmax降低观察到24个月后，CXL失去了显着性在36 months.CONCLUSIONS：交联似乎是安全的儿童和青少年。88%发生圆锥角膜进展。我们建议等待进展的文件不是强制性的，儿童和青少年的CXL应该在诊断后立即进行。然而，阻止疾病进展的效果可能不像成人那样持久，需要更长时间的随访来验证这一趋势。[J Refract Surg.2012;28（11）：753-758.] doi：10.3928/1081597X-20121011-01
PURPOSE: To study the progression rate of keratoconus and assess the clinical outcome of corneal collagen cross-linking (CXL) with riboflavin and ultraviolet A light in children and adolescent patients up to 3 years after treatment.METHODS: Fifty-nine eyes from 42 children and adolescents (aged 9 to 19 years) with confirmed keratoconus were included in this retrospective interventional cohort study. Refraction, slit-lamp examination, Placido-based corneal topography, and Scheimpflug imaging were performed bilaterally in all patients preoperatively and at 6 and 12 months postoperatively. Maximal keratometry readings (Kmax), corrected distance visual acuity (CDVA), corneal thickness, and the keratoconus index (KI) were analyzed. Follow-up was up to 36 months (mean follow-up: 26.3 months [range: 12 to 36 months]).RESULTS: Fifty-two of the 59 eyes enrolled in this study showed progression, corresponding to a progression rate of 88%. Forty-six eyes were treated by CXL. Maximal keratometry, CDVA, and KI showed significant changes over the follow-up period. However, significant Kmax reduction observed up to 24 months after CXL lost significance at 36 months.CONCLUSIONS: Cross-linking seems to be safe in children and adolescents. Progression of keratoconus occurred in 88%. We propose that awaiting documentation of progression is not mandatory and CXL in children and adolescents should be performed as soon as the diagnosis has been made. However, the effect of arrest of disease progression might not be as long-lasting as in adults and longer follow-up is needed to verify this trend. [J Refract Surg. 2012;28(11):753-758.] doi:10.3928/1081597X-20121011-01