Título

Early corneal cross-linking on progressive keratoconus

Introdução

Keratoconus is a bilateral, noninflammatory corneal degenerative disorder that leads to paracentral corneal thinning and secondary ectasia, resulting in irregular astigmatism with impaired vision. Younger patients are a population particularly at risk for faster progression of the disease and corneal collagen cross-linking (CXL) is the only treatment that aims to stop or decrease progression of keratoconus. The aim of this study is to compare early CXL intervention patients (16 years-old or less) with the late intervention patients (17 years-old or more) on keratoconus’s features and progression after the CXL procedure.

Método

In this retrospective study, data were collected from 105 eye of 94 patients with keratoconus undergoing treatment with CXL. Patients were divided by age in two groups: group 1 (16 years old or less) and group 2 (17 years old or more). Eyes were evaluated by assessment for best corrected visual acuity (BCVA), refraction, slit lamp biomicroscopy, Goldmann tonometry, corneal endothelium cell density (ECD), central corneal thickness (CCT) and keratometry test prior to CXL and 1, 3, 6 and 12 months after.

Resultados

Mean (SD) age was 13.8 (± 1.84) years in group 1 and 21.5 (± 5.09) years in group 2. Group 1 mean (SD) BCVA were 0.45 (± 0.25) pre-CXL and 0.56 (± 0.29) one year after CXL (p 0.030); mean (SD) ECD were 2659.0 (± 120.7) pre-CXL and 2504.8 (± 141.8) one year after CXL (p 0.0002); mean (SD) CCT were 466.60 (± 45.15) pre-CXL and 426.07 (± 67.48) one year after CXL (p 0.009); mean (SD) Kmax, Ksteep and Kflat were respectively 58.47 (± 7.16), 52.93 (± 5.42), 47.22 (± 4.19) pre-CXL and 58.21 (± 7.68), 52.25 (± 5.49), 46.56 (± 4.65) one year after CXL (p 0.897, 0.481 and 0.491). Group 2 mean (SD) BCVA were 0.50 (± 0.30) pre-CXL and 0.56 (± 0.32) one year after CXL (p 0.346); mean (SD) ECD were 2630.0 (± 284.0) pre-CXL and 2457.6 (± 335.8) one year after CXL (p 0.043); mean (SD) CCT were 453.30 (± 38.82) pre-CXL and 415.03 (± 51.15) one year after CXL (p 0.0018); mean (SD) Kmax, Ksteep and Kflat were respectively 57.64 (± 7.10), 54.02 (± 6.22), 48.60 (± 4.06) pre-CXL and 56.46 (± 8.01), 52.46 (± 5.79), 47.85 (± 4.86) one year after CXL (p 0.553, 0.258 and 0.640).

Conclusões

The study showed no statistical difference between groups. We suggest early indication of CXL treatment for the benefit of early stabilization of the disease and better evolution of BCVA and keratometry parameters.