Cornea · 2026
Comparison of Efficacy and Safety of Contact Lens-Assisted Corneal Collagen Crosslinking and Hypoosmolar Corneal Collagen Crosslinking in Pediatric Patients With Keratoconus and Thin Corneas.
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Jain Parul, Annadevula Gahan Reddy, Gupta Isha, Dutta Paromita
Аннотация
PURPOSE: The aim of this study was to compare the efficacy and safety of contact lens-assisted corneal collagen crosslinking (CXL) and hypoosmolar CXL in pediatric patients with progressive keratoconus and thin corneas.
METHODS: Forty eyes of 40 progressive pediatric patients with keratoconus and thin corneas were divided into two groups: the first group underwent contact lens-assisted CXL (CL group), and the second group underwent hypoosmolar riboflavin-assisted CXL (group H). Only patients younger than 18 years with thinnest corneal pachymetry <400 μm were included. The primary outcomes measured were the changes in maximum keratometry (Kmax) on Sirius topography and in endothelial cell count at 6 months postoperatively; the secondary outcome measured was the change in best spectacle-corrected visual acuity at 6 months postoperatively. The demarcation line on anterior segment optical coherence tomography was also recorded at 1 month after CXL.
RESULTS: Kmax showed a significant decrease at 6 months after CXL from 65.56 ± 8.19 diopters preoperatively to 63.6 ± 8.27 diopters in the CL group and from 65.61 ± 14.69 diopters preoperatively to 63.14 ± 13.69 diopters in group H. The mean demarcation line depth was 198.89 ± 42.42 μm in the CL group and 215.4 ± 59.01 μm in group H. Both groups showed no significant decrease in endothelial cell count after CXL.
CONCLUSIONS: Both methods compared above suggest a halt in the progression of keratoconus for the study duration of 6 months in pediatric patients with thin corneas, thus negating the need for corneal transplantation in these patients. Because there are limited randomized trials on management of pediatric keratoconus with thin corneas, the results of this study will be useful in guiding clinical decisions.
METHODS: Forty eyes of 40 progressive pediatric patients with keratoconus and thin corneas were divided into two groups: the first group underwent contact lens-assisted CXL (CL group), and the second group underwent hypoosmolar riboflavin-assisted CXL (group H). Only patients younger than 18 years with thinnest corneal pachymetry <400 μm were included. The primary outcomes measured were the changes in maximum keratometry (Kmax) on Sirius topography and in endothelial cell count at 6 months postoperatively; the secondary outcome measured was the change in best spectacle-corrected visual acuity at 6 months postoperatively. The demarcation line on anterior segment optical coherence tomography was also recorded at 1 month after CXL.
RESULTS: Kmax showed a significant decrease at 6 months after CXL from 65.56 ± 8.19 diopters preoperatively to 63.6 ± 8.27 diopters in the CL group and from 65.61 ± 14.69 diopters preoperatively to 63.14 ± 13.69 diopters in group H. The mean demarcation line depth was 198.89 ± 42.42 μm in the CL group and 215.4 ± 59.01 μm in group H. Both groups showed no significant decrease in endothelial cell count after CXL.
CONCLUSIONS: Both methods compared above suggest a halt in the progression of keratoconus for the study duration of 6 months in pediatric patients with thin corneas, thus negating the need for corneal transplantation in these patients. Because there are limited randomized trials on management of pediatric keratoconus with thin corneas, the results of this study will be useful in guiding clinical decisions.