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Corneal Cross Linking in Pediatric Keratoconus

  • Vasilios F. Diakonis
  • Mohammad Shehadeh
Chapter

Abstract

Keratoconus in pediatric patients is in most cases underdiagnosed when compared to adults. This probably is due to the acceptable visual function that early stages of keratoconus permit, which does not influence activities of daily life; a condition not evident neither by the patient nor by the patients’ environment (parents, guardians, teachers etc). The major concern of keratoconus in this age group comprises of the accelerated progression the disease may demonstrate (corneal tissue more biomechanically vulnerable in young patients), with these patients having a sevenfold higher risk of requiring corneal grafting in the future. The introduction of corneal collagen cross linking (CXL) in clinical practice more than a decade ago, changed the management of keratoconus. This treatment approach has decreased the need for corneal transplantations and in some cases improves visual function due to the corneal flattening and surface regularization it achieves. Thereby early diagnosis and appropriate treatment is paramount especially in pediatric patients, while the current literature supports the efficacy of CXL in halting or delaying keratoconus progression in pediatric patients.

Keywords

Pediatric keratoconus Corneal elasticity Corneal cross linking 

References

  1. 1.
    Rabinowitz YS. Keratoconus. Surv Ophthalmol. 1998;42(4):297–319.CrossRefGoogle Scholar
  2. 2.
    Davis LJ, Schechtman KB, Wilson BS, et al. Longitudinal changes in visual acuity in keratoconus. Invest Ophthalmol Vis Sci. 2006;47(2):489–500.CrossRefGoogle Scholar
  3. 3.
    Davidson AE, Hayes S, Hardcastle AJ, et al. The pathogenesis of keratoconus. Eye. 2014;28:189–95.CrossRefGoogle Scholar
  4. 4.
    Leoni-Mesplie S, Mortemousque B, Touboul D, et al. Scalability and severity of keratoconus in children. Am J Ophthalmol. 2012;154:56–62.CrossRefGoogle Scholar
  5. 5.
    Kymionis GD, Grentzelos MA, Liakopoulos DA, et al. Long-term follow-up of corneal collagen cross-linking for keratoconus—the cretan study. Cornea. 2014;33:1071–9.CrossRefGoogle Scholar
  6. 6.
    Reeves SW, Stinnett S, Adelman RA, et al. Risk factors for progression to penetrating keratoplasty in patients with keratoconus. Am J Ophthalmol. 2005;4:607–11.Google Scholar
  7. 7.
    Gunes A, Tok L, Tok Ö, Seyrek L. The youngest patient with bilateral keratoconus secondary to chronic persistent eye rubbing. Semin Ophthalmol. 2015;30(5–6):454–6.CrossRefGoogle Scholar
  8. 8.
    Shehadeh MM, Diakonis VF, Jalil SA, et al. Prevalence of keratoconus among a palestinian tertiary student population. Open Ophthalmol J. 2015;9:172–6.CrossRefGoogle Scholar
  9. 9.
    Hashemi H, Beiranvand A, Khabazkhoob M, et al. Prevalence of keratoconus in a population-based study in Shahroud. Cornea. 2013;32:1441–5.CrossRefGoogle Scholar
  10. 10.
    Godefrooij DA, de Wit GA, Uiterwaal CS, et al. Age-specific incidence and prevalence of keratoconus: a nationwide registration study. Am J Ophthalmol. 2017;175:169–72.CrossRefGoogle Scholar
  11. 11.
    Saini JS, SarohaV, Singh P, et al. Keratoconus in Asian eyes at a tertiary eye care facility. Clin Exp Optom. 2004;87:97–101.CrossRefGoogle Scholar
  12. 12.
    Chatzis N, Hafezi F. Progression of keratoconus and efficacy of corneal collagen cross-linking in children and adolescents. J Refract Surg. 2012;28:753–8.CrossRefGoogle Scholar
  13. 13.
    Soeters N, Van der Valk R, Tahzib NG. Corneal crosslinking for treatment of progressive keratoconus in various age groups. J Refract Surg. 2014;30:454–60.CrossRefGoogle Scholar
  14. 14.
    Zotta PG, Moschou KA, Diakonis VF, et al. Cornealcollagen cross-linking for progressive keratoconus in pediatricpatients: a feasibility study. J Refract Surg. 2012;28:793–6.CrossRefGoogle Scholar
  15. 15.
    Arora R, Gupta D, Goyal JL, et al. Results ofcorneal collagen cross-linking in pediatric patients. J Refract Surg. 2012;28:759–62.CrossRefGoogle Scholar
  16. 16.
    Vinciguerra P, Alb’e E, Frueh BE, et al. Two-year corneal cross-linking results in patients youngerthan 18 yearswith documented progressive keratoconus. Am J Ophthalmol. 2012;154:520–6.CrossRefGoogle Scholar
  17. 17.
    Wollensak G, Iomdina E. Biomechanical and histological changes after cornealcrosslinking with and without epithelial debridement. J Cataract Refract Surg. 2009;35(3):540–6.CrossRefGoogle Scholar
  18. 18.
    Hanna R, Berkwitz E, Castillo E, et al. Collagen cross-linking for the treatment of keratoconus in pediatric patients. Int J Kerat Ect Cor Dis. 2015;4(3):94–9.Google Scholar
  19. 19.
    Panos GD, Kozeis N, Balidis M, et al. Collagen cross- linkingfor paediatric keratoconus. Open Ophthalmol J. 2017 Jul 31;11:211–6.CrossRefGoogle Scholar
  20. 20.
    El Rami H, Chelala E, Dirani A, et al. An Update on the safety and efficacy of corneal collagen cross-linking in pediatric keratoconus. Biomed Res Int. 2015;2015:257927.PubMedPubMedCentralGoogle Scholar
  21. 21.
    Kankariya VP, Kymionis GD, Diakonis VF, et al. Management of pediatrickeratoconus - evolving role of corneal collagen cross-linking: an update. Indian J Ophthalmol. 2013 Aug;61(8):435–40.CrossRefGoogle Scholar
  22. 22.
    Magli A, Forte R, Tortori A, et al. Epithelium-offcorneal collagen cross-linking versus transepithelial cross-linking for pediatrickeratoconus. Cornea. 2013;32(5):597–601.CrossRefGoogle Scholar
  23. 23.
    Caporossi A, Mazzotta C, Baiocchi S, et al. Long term results of riboflavin ultraviolet a corneal collagen crosslinking for keratoconus in Italy: the Siena eye cross study. Am J Ophthalmol. 2010;149:585–93.CrossRefGoogle Scholar
  24. 24.
    Barbara R, Pikkel J, Garzozi H, et al. Collagen cross-linking and keratoconus in pediatric patients. Int J Keratoco Ectatic Corneal Dis. 2012;1(1):57–60.CrossRefGoogle Scholar
  25. 25.
    Bakshi E, Barkana Y, Goldich Y, et al. Corneal cross-linking for progressive keratoconus in children: our experience. Int J Keratoco Ectatic Corneal Dis. 2012;1(1):53–6.CrossRefGoogle Scholar
  26. 26.
    Bakshi E, Barequet IS, Aizenman I, et al. Corneal crosslinking in patients younger than 18 years: Long-term follow up in three Israeli medical centers. Int J Kerat Ect Cor Dis. 2014;3(2):84–7.Google Scholar
  27. 27.
    Malik NS, Moss SJ, Ahmed N, et al. Ageing of the human corneal stroma: structural and biochemical changes. Biochim Biophys Acta. 1992;1138:222–8.CrossRefGoogle Scholar
  28. 28.
    Kymionis GD, Tsoulnaras KI, Grentzelos MA, et al. Topography-based keratoconus regression. Cornea. 2013;32(10):1402–6.CrossRefGoogle Scholar
  29. 29.
    Touboul D, Efron N, Smadja D, et al. Corneal confocal microscopy following conventional, transepithelial, and accelerated corneal collagen cross-linking procedures for keratoconus. J Refract Surg. 2012;28:769–75.CrossRefGoogle Scholar
  30. 30.
    Shetty R, Nagaraja H, Jayadev C et al. Accelerated corneal collagen cross-linking in pediatric patients: two-year follow-up results. Biomed Res Int. 2014;894095.Google Scholar
  31. 31.
    Ozgurhan EB, Kara N, K. Cankaya I, et al. Accelerated corneal cross-linking in pediatric patients with keratoconus: 24-month outcomes. J Refract Surg. 2014;12:843–9.CrossRefGoogle Scholar
  32. 32.
    Waszczykowska A, Jurowski P. Two-year accelerated corneal cross-linking outcome in patients with progressive keratoconus. Biomed Res Int. 2015.Google Scholar
  33. 33.
    Touboul D, Efron N, Smadja D, et al. Corneal confocal microscopy following conventional, transepithelial, and accelerated corneal collagen cross-linking procedures for keratoconus. J Refract Surg. 2012;28:769–75.CrossRefGoogle Scholar
  34. 34.
    Ozgurhan EB, Akcay BIS, Yildirim Y et al. Evaluation of corneal stromal demarcation line after two different protocols of accelerated corneal collagencross-linking procedures using anterior segment opticalcoherence tomography and confocal microscopy. J Ophthalmol. 2014;2014:5 pages.Google Scholar
  35. 35.
    Mrochen M. Current status of accelerated corneal cross-linking. Indian J Ophthalmol. 2013;61(8):428–9.CrossRefGoogle Scholar
  36. 36.
    Cınar Y, Cingü AK, Türkcü FM, et al. Comparison of accelerated and conventional corneal collagen cross-linking for progressive keratoconus. Cutan Ocul Toxicol. 2014;33(3):218–22.CrossRefGoogle Scholar
  37. 37.
    Abdelmassih Y, El-Khoury S, Dirani A, et al. Safety and efficacy of sequential intracorneal ring segment implantation and cross-linking in pediatric keratoconus. Am J Ophthalmol. 2017;178:51–7.CrossRefGoogle Scholar
  38. 38.
    Abozaid MA. Sequential Keraring implantation and corneal cross-linking for the treatment of keratoconus in children with vernal keratoconjunctivitis. Clin Ophthalmol (Auckland, NZ). 2017;11:1891–5.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Vasilios F. Diakonis
    • 1
  • Mohammad Shehadeh
    • 2
  1. 1.The Eye Institute of West FloridaLargoUSA
  2. 2.An-Najah National University Hospital, Faculty of Medicine and Health Sciences, An-Najah National UniversityNablusPalestine

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