Treatment of progressive keratoconus

2 August 2024 | Fiona Rowe (Prof) | EYE - Paediatrics, EYE - Strabismus

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This study aimed to analyse the clinical results of accelerated iontophoresis-assisted epithelium corneal cross-linking (i-ON CXL) to evaluate the risk factors for keratoconus progression after treatment, and the safety and efficacy of re-treatment using epithelium-off CXL protocol in paediatric patients. This was a retrospective study of data from 16 eyes of 16 patients (11 males, five females) with ages of 10–17 years (mean 14.6 ±2.5 years). All underwent i-ON CXL for progressive keratoconus. Keratoconus location was central for 10 patients and paracentral for six. At two years post-treatment, there was significant worsening of the mean maximum keratometry index (Kmax) and steepest keratometry reading. The mean minimal corneal thickness (MCT) reduced significantly. There were significant mean anterior and posterior elevation values at the thinnest point at two years. Two patients had keratoconus progression after the first year, 10 with increase after two years and four were stable. There was a significant correlation with age and progression after treatment. Treatment was less effective in younger patients but with efficacy for older children up to two years follow-up. Twelve patients were in the re-treatment group. After two years, visual acuity was unchanged. There was a significant decrease in Kmax measurements. At two years, there was no increase of Kmax measurements >1D. The authors reported this was a well-tolerated procedure. Eight patients had a painful sensation for two days post-treatment but there were no complications and all were stable at two years. Re-treatment proved effective to halt keratoconus progression after i-on CXL failure. Further study is warranted with larger patient numbers and longer follow-up periods.