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  • General anesthesia is a viable option for CXL patients who are unable to tolerate topical anesthesia

    Pediatric Ophth/Strabismus, Refractive Mgmt/Intervention

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    Review of: Corneal Collagen Cross-Linking Under General Anesthesia for Pediatric Patients With Keratoconus and Developmental Delay

    Ahmad T, Pasricha N, Rose-Nussbaumer J, et al. Cornea, May 2020

    This retrospective single-center case series reports the characteristics and outcomes of pediatric patients with keratoconus who underwent corneal crosslinking (CXL) under general anesthesia.

    Study design

    Data was collected from 14 eyes of 9 patients preoperatively and at postoperative week 1, month 1 and month 6. Crosslinking was performed using the standard epithelium-off Dresden protocol. The main outcomes were anesthesia complications, surgical complications, postoperative BCVA, keratometry values, and eye-rubbing behavior. Baseline characteristics of patients with and without developmental delay were also compared.

    Outcomes

    Six patients had developmental delay and 3 did not. Compared with the nondevelopmentally delayed patients, those with delay were diagnosed at a later age (16.0 vs. 13.9 years, P=0.097), experienced longer wait times between diagnosis and surgery (20.7 vs. 8.8 weeks, P=0.262), had worse baseline BCVA (20/70 vs. 20/40, P=0.258), higher baseline steep K values (54.0 vs. 50.9, P=0.305) and a higher incidence of corneal scarring at baseline (75.0% vs. 33.3%, P=0.119). Six-month data was available for 11 (78.6%) eyes. There were no anesthesia or surgical complications. At postoperative month 6, BCVA and steep K values were stable and eye-rubbing behavior improved or resolved in 8 of the 9 patients.

    Limitations

    This study is limited by its retrospective nature, small sample size, and limited length of follow-up. Data at 6 months were only available for 11 eyes and it was not possible to measure BCVA in 3 of those.

    Clinical significance

    Early diagnosis and treatment of keratoconus is of utmost importance, especially in patients with developmental delay who may not be good candidates for keratoplasty. Crosslinking under general anesthesia appears to be a safe and effective option for patients who are unable to cooperate with the procedure under topical anesthesia in the office setting.