Paediatric cornea crosslinking current strategies:A review

作     者：Pawan Prasher Ashok Sharma Rajan Sharma Vipan K.Vig Verinder S.Nirankari 

作者机构：Department of OphthalmologySri Guru Ram Das Institute of Medical Sciences and ResearchAmritsarPunjabIndia Cornea CentreSCO 2463-2464Sector 22 C160022ChandigarhIndia Amritsar Eye HospitalGNDU Shopping ComplexAmritsarPunjabIndia Department of OphthalmologyUniversity of MarylandUSA 

出 版 物：《Advances in Ophthalmology Practice and Research》 (眼科实践与研究新进展（英文）)

年 卷 期：2023年第3卷第2期

页      面：55-62页

学科分类：1002[医学-临床医学] 100214[医学-肿瘤学] 10[医学] 

主　　题：Keratoconus Corneal collagen cross-linking Corneal transplant Pediatric keratoconus 

摘      要：Background:In the general population,1 in 2000 people has keratoconus.Indians and other people from Southeast Asia have a higher incidence of keratoconus.Children with keratoconus typically present earlier in life and with a more severe disease.Rubbing the eyes has been identified as a risk factor.Children have a higher incidence and a faster rate of keratoconus progression.Visual rehabilitation in children with keratoconus is challenging.They have a low compliance with contact lens use.Many of these children require penetrating keratoplasty at an early age.Therefore,stopping the progression of keratoconus in children is of paramount importance.Main text:Compared to treatment,keratoconus progression prophylaxis is not only preferable,but also easier.Corneal collagen cross-linking has been shown to be safe and effective in stopping its progression in children.The Dresden protocol,which involves central corneal deepithelization(7-9 mm),saturation of the stroma with riboflavin(0.25%),and 30 min UV-A exposure,has proven to be the most successful.Two significant disadvantages of the typical Dresden regimen are the prolonged operating time and the significant post-operative pain.Accelerated-CXL(9 mW/cm^(2) x 10 min)has been studied to reduce operative time and has been shown to be equally effective in some studies.Compared to accelerated CXL or traditional CXL,epi-off procedures,transepithelial treatment without the need for de-epithelialization and without postoperative discomfort,have been shown to be safer but less effective.Corneal crosslinking should only be performed after treating children with active vernal keratoconjunctivitis.Corneal opacity,chronic corneal edema,sterile infiltrates,and microbial keratitis have been reported after cross-linking of corneal collagen.Conclusions:TheDresden protocol,also known as the conventional corneal cross-linking approach,should be used to halt the progression of keratoconus in young patients.However,if the procedure needs to be completed more rapidly,accelerated corneal crosslinking may be considered.Transepithelial corneal cross-linking has been proven to be less effective at stabilizing keratoconus,although being more safer.