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Long-term results of accelerated corneal collagen crosslinking in paediatric patients with progressive keratoconus: 10-year follow-up

Eye (2024)Cite this article

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Abstract

Objectives

To evaluate the 10-year visual, refractive, and tomographic outcomes of epithelium-off accelerated corneal collagen cross-linking (ACCL) in paediatric patients with progressive keratoconus (KC) and to compare the stages in terms of re-progression.

Methods

Patients under 18 years of age with progressive KC who underwent ACCL between 2010 and 2012 and completed at least 10 years of follow-up were included in this retrospective study. Uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), refractive errors, and corneal tomography parameters were evaluated preoperatively and at 1, 5, and 10 years postoperatively. The effect of stage and age on re-progression was analysed.

Results

The study included 175 eyes of 97 patients (mean age: 14.46 ± 2.17 years). Improvement in UDVA and CDVA was observed in all postoperative periods compared to the preoperative period (each p-value < 0.05). The increase in spherical equivalent (SE), flattening of keratometry values, and decrease in thinnest corneal thickness (TCT) were statistically significant in the tenth year compared to preoperatively (each p-value < 0.05). Re-progression was observed in 16 eyes (9.14%). Haze was observed in 13 eyes (7.43%), 4 of which were permanent. Deep anterior lamellar keratoplasty was performed in 3 eyes (1.7%) and a second ACCL in 3 eyes (1.7%).

Conclusions

ACCL is an effective and safe long-term strategy to prevent progression of KC in paediatric patients. In the light of this study with a 10-year follow-up re-progression rate of 9.14%, long-term follow-up of patients after ACCL for possible re-progression and the need for re-CCL or keratoplasty may be recommended.

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Fig. 1: Changes in visual parameters over time.
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Data availability

All data generated or analysed during this study are included in this published article.

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Acknowledgements

The authors would like to thank Havva Kanbak for her contribution to obtaining corneal tomography images.

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Authors and Affiliations

  1. University of Health Sciences, Beyoglu Eye Training and Research Hospital, Department of Ophthalmology, Istanbul, Turkey

    Sibel Ahmet, Gizem Yayla Akincilar, Ahmet Kirgiz, Nilay Kandemir Besek, Burcu Kemer Atik, Husna Topcu & Gunes Gumus Kasapoglu

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Contributions

SA and BKA wrote the main text of the article. AK and HT led several revisions. HT reviewed and revised the manuscript, and GY and GG collected data and prepared figures. NKB served as the primary senior editor. All authors reviewed the manuscript.

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Correspondence to Sibel Ahmet.

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The authors declare no competing interests.

Ethics approval and consent to participate

The study was approved by the ‘U.H.S. Istanbul Training and Research Hospital Clinical Research Ethics Committee with reference number 211/2023. Informed consent was obtained from all the study participants and from the parents or legal guardians of each patient involved in the study. The study was conducted in accordance with the Declaration of Helsinki.

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Ahmet, S., Yayla Akincilar, G., Kirgiz, A. et al. Long-term results of accelerated corneal collagen crosslinking in paediatric patients with progressive keratoconus: 10-year follow-up. Eye (2024). https://doi.org/10.1038/s41433-024-03064-7

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