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Conner E, Gagrani M, Lalgudi VG, Shah PR, Hiasat J, Jhanji V, Nischal KK. Corneal Collagen Cross-linking for Keratoconus in Pediatric and Developmentally Delayed Patients. Cornea 2024:00003226-990000000-00589. [PMID: 39047195 DOI: 10.1097/ico.0000000000003562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 03/24/2024] [Indexed: 07/27/2024]
Abstract
PURPOSE Corneal cross-linking (CXL) is the standard of care in patients with keratoconus but presents unique challenges in children and developmentally delayed patients. We present our clinical decision-making algorithm, CXL surgical technique, and outcomes in these groups. METHODS A retrospective chart review was undertaken at a tertiary referral center of all patients who underwent CXL for keratoconus at University of Pittsburgh Medical Center (UPMC) Children's Hospital of Pittsburgh between October 1, 2017, and April 1, 2021. Demographic information along with preoperative, intraoperative, and postoperative ophthalmic examination findings were collected. The main outcome measures were indications of CXL, postoperative complications, and visual acuity (VA). RESULTS Forty-eight eyes of 34 patients [21 patients (30 eyes) with developmental delay (DD) and 13 patients (18 eyes) with no DD (NDD)] underwent epithelium-off, standard CXL. General anesthesia was used for CXL in all patients except for 3 with NDD. A temporary central tarsorrhaphy was performed in all patients with DD and 7 patients with NDD. The remaining got a bandage contact lens. There were no immediate postoperative complications. A trend toward improvement in VA was noted postoperatively. The mean logMAR VA (with habitual correction) was 0.67 preoperatively and 0.57 postoperatively (P = 0.3) in DD and 0.52 and 0.36, respectively (P = 0.13), in NDD. CONCLUSIONS This retrospective review presents a technique for assessment and treatment of keratoconus in children and those with DD. Our technique ensures timely diagnosis and provides a safe method for CXL in these groups. Temporary central tarsorrhaphy is a well-tolerated option to reduce postoperative pain.
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Affiliation(s)
- Elizabeth Conner
- Division of Pediatric Ophthalmology and Strabismus, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA. Dr. Conner is now with the Department of Ophthalmology, Christchurch Hospital, Christchurch, New Zealand and Dr. Shah is now with the Discipline Clinical Ophthalmology, The University of Sydney, Sydney, Australia
| | - Meghal Gagrani
- Division of Pediatric Ophthalmology and Strabismus, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA. Dr. Conner is now with the Department of Ophthalmology, Christchurch Hospital, Christchurch, New Zealand and Dr. Shah is now with the Discipline Clinical Ophthalmology, The University of Sydney, Sydney, Australia
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA; and
| | - Vaitheeswaran G Lalgudi
- Department of Ophthalmology, University at Buffalo, State University of New York, Buffalo, NY
| | - Parth R Shah
- Division of Pediatric Ophthalmology and Strabismus, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA. Dr. Conner is now with the Department of Ophthalmology, Christchurch Hospital, Christchurch, New Zealand and Dr. Shah is now with the Discipline Clinical Ophthalmology, The University of Sydney, Sydney, Australia
| | - Jamila Hiasat
- Division of Pediatric Ophthalmology and Strabismus, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA. Dr. Conner is now with the Department of Ophthalmology, Christchurch Hospital, Christchurch, New Zealand and Dr. Shah is now with the Discipline Clinical Ophthalmology, The University of Sydney, Sydney, Australia
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA; and
| | - Vishal Jhanji
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA; and
| | - Ken K Nischal
- Division of Pediatric Ophthalmology and Strabismus, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA. Dr. Conner is now with the Department of Ophthalmology, Christchurch Hospital, Christchurch, New Zealand and Dr. Shah is now with the Discipline Clinical Ophthalmology, The University of Sydney, Sydney, Australia
- Department of Ophthalmology, University at Buffalo, State University of New York, Buffalo, NY
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Güçlü H, Akaray İ, Kaya S, Sattarpanah S, Çınar AC, Sakallıoğlu K, Korkmaz S, Gürlü V. Agreement of Anterior Segment Parameters Between Schiempflug Topography and Swept-Source Optic Coherence Based Optic Biometry in Keratoconus and Healthy Subjects. Eye Contact Lens 2021; 47:539-545. [PMID: 33813587 DOI: 10.1097/icl.0000000000000787] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE The aim of this study is to compare anterior segment parameters, including corneal thickness (CCT), keratometry and anterior chamber depth (ACD), and white to white corneal diameter (WTW), obtained by Pentacam Schiempflug imaging and intraocular lens (IOL) Master 700 swept-source optic coherence tomography biometry in keratoconus patients and healthy subjects. METHODS This prospective cross-sectional instrument agreement analysis includes 88 eyes of 50 keratoconus patients and 87 eyes of 50 healthy subjects. Biometry was performed using IOL Master 700, and topography was performed using Pentacam. The keratometry values (Kf, Ks, Km, and Kmax), ACD, WTW, CCT, axial length (AL), anterior chamber angle (ACA), and lens thickness (LT) were evaluated. Levels of agreement between devices were evaluated by Bland-Altman plots with 95% limits of agreement. RESULTS Intraocular lens Master 700 showed higher WTW, ACD, pupil diameter, and CCT values than Pentacam in both the keratoconus and control groups. However, there were no statistically significant differences in flat keratometry (Kf) and steep keratometry (Ks) values between the groups. CONCLUSION Pentacam and IOL Master 700 may be used interchangeably in normal eyes and keratoconus eyes for the measurement of keratometry values and axis; however, these two devices should not be considered interchangeable for WTW, ACD, pupil diameter, and CCT measurements in both keratoconus patients and healthy subjects.
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Affiliation(s)
- Hande Güçlü
- Department of Ophthalmology (H.G., İ.A., S. Kaya, S.S., A.C.Ç., K.S., V.G.), Trakya University of Medicine, Edirne, Turkey; and Department of Biostatistics and Medical Informatics (S. Korkmaz), Trakya University of Medicine, Edirne, Turkey
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