Standard epi-off cross-linking safe in children, but progression may restart later in some cases
MAASTRICHT, Netherlands — Standard epi-off corneal cross-linking is effective in arresting keratoconus in children and is as safe as in adult procedures, according to studies reviewed by a specialist here. However, doubts remain about long-term stability.
“Five years is the longest follow-up we have in studies. Most of them cover a shorter period and fail to state whether all patients completed the follow-up,” Beatrice Frueh, MD, said at the European Society of Cataract and Refractive Surgeons winter meeting.
Children have more severe keratoconus, which progresses faster and should be treated without delay, she said.
Transepithelial cross-linking, which would be desirable, has failed to show positive results. In two studies, one published by Buzzonetti and colleagues in 2012 and the other by the group of Caporossi in 2013, epi-on did not arrest progression and required re-treatment with epi-off in at least half of the cases. Iontophoresis also had disappointing outcomes, while accelerated cross-linking in a 2014 study by Shetty and colleagues showed 10% progression at 2 years.
Better results were shown by two studies by Ucakhan and colleagues and Godefrooij and colleagues following the standard Dresden protocol. No re-treatment or transplantation was performed over the study period of 4 years and 5 years, respectively. In the latter study, cases of pseudo-progression were found, probably due to the inclusion of very steep corneas, without loss of a single Snellen line.
“Five-year results of our own prospective study in Bern, using the standard Dresden protocol and including 23 eyes of 19 children, showed improved VA with a tendency to less myopia. The corneas flattened, and topography indexes improved or remained unchanged. Surprisingly, however, a constant corneal thinning occurred. At 3 years, we have had two cases of progression, both re-treated and now stable,” Frueh said. – by Michela Cimberle
Frueh B. Indications and long-term results in children. European Society of Cataract and Refractive Surgeons winter meeting; Feb. 10-12, 2017; Maastricht, Netherlands.
Disclosure: Frueh reports no relevant financial disclosures.