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    More Support for CXL in Young Keratoconus Patients

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    Research from Stanford University confirms that corneal cross-linking (CXL) stabilizes and may improve visual and corneal parameters in children and young adults with keratoconus. This new evidence adds to that from previ­ous studies supporting CXL as a safe, well-tolerated intervention in these younger patients with keratoconus.1

    CXL Results

    CXL RESULTS. In this Pentacam set, the pre-op, post-op, and difference map images show the flattening that occurs following CXL.

    Reassuring outcomes in kids. Kera­toconus typically starts at puberty but may also occur in younger children. “We were curious to see how well CXL worked in a cohort of young patients with keratoconus,” said study coauthor Edward E. Manche, MD. He added, “We were expecting to have similar results to previously published studies. Our results confirmed that the technique is safe and effective in this group of patients.”

    Study details. The researchers retro­spectively reviewed the medical records of 49 keratoconus patients (57 eyes) between the ages of 12 and 22 years who underwent CXL between January 2013 and November 2019 at Byers Eye Institute at Stanford University in Palo Alto, California. Eight of these patients underwent bilateral CXL.

    Outcome measures included various visual and corneal parameters taken at baseline and at 12 and 24 months postoperatively. The researchers’ analysis revealed post-CXL improvement in corrected distance visual acuity (CDVA), with a mean CDVA of 0.38 ± 0.32 at baseline, a mean CDVA of 0.29 ± 0.31 at 12 months post-op, and a mean CDVA of 0.31 ± 0.31 at 24 months post-op. A significant improvement in maximum keratometry was seen at 12 and 24 months post-CXL.

    Corneal thinning (as measured by minimum central corneal thickness) initially occurred but stabilized by 24 months post-CXL. The procedure was well-tolerated by all patients, with no lasting side effects reported. There were no cases of microbial keratitis or delayed epithelial healing beyond one month. Two eyes continued to have mild haze at the 24-month examina­tion, but this was not visually signifi­cant.

    A call for early intervention. CXL has become a first-line treatment for keratoconus in adults. Although the condition typically progresses more rapidly in children, standardization of its management in pediatric patients is lacking.

    “I believe that we should implement topographic screening protocols for children and young adolescents in or­der to identify patients with keratoco­nus at an early stage,” said Dr. Manche. He added that earlier diagnosis and treatment of keratoconus “can prevent the long-term morbidity of the disease, including need for specialty contact lenses and corneal transplantation.”

    —Patricia Weiser, PharmD

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    1 Saleh S et al. Cornea. 2022;41(4):408-416.

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    Relevant financial disclosures—Dr. Manche: NIH: S; Research to Prevent Blindness: S.

    For full disclosures and the disclosure key, see below.

    Full Financial Disclosures

    Dr. Hwang Catholic University of Korea: P; Ministry of Education, Republic of Korea: S.

    Dr. Manche Alcon: S; Allergan: S; Avedro: C,S; Carl Zeiss Meditec: S; Johnson & Johnson Vision: C,S; NIH: S; Novartis: S; Placid0: P,S; Presbia: S; Research to Prevent Blindness: S; RxSight: U,S; VacuMed: P,S.

    Dr. Ten Hulzen None.

    Dr. Wykoff Adverum: C,S; Aerie: S; Aldeyra: S; Alimera Sciences S; Allergan: C; Apellis: C,S; Bausch + Lomb: C; Bayer: C,S; Bionic Vision Technologies: C; Boehringer Ingelheim: S; Chengdu Kanghong: C,S; Clearside Biomedical: C,S; Eye­Point: C; Gemini Therapeutics: S; Genentech: C,S; Graybug Vision: S; Gyroscope: C,S; Ionis Pharmaceutical: S; IVERIC Bio: C,S; Kato: C; Kodiak Sciences: C,S; LMRI: S; NGM Biopharmaceuticals: C,S; Novartis: C,S; OccuRx: C; Ocular Therapeutix: C; ONL Therapeutics: C,O; Opthea: C,S; Ox­urion: C,S; Palatin: C; PolyPhotonix: C,O; RecensMedical: C,O,S; Regeneron: C,S; RegenXBio: C,S; Roche: C,S; Sant­en: S; Takeda: C; Visgenx: C,O: Xbrane Biopharma: S.

    Disclosure Category

    Code

    Description
    Consultant/Advisor C Consultant fee, paid advisory boards, or fees for attending a meeting.
    Employee E Hired to work for compensation or received a W2 from a company.
    Employee, executive role EE Hired to work in an executive role for compensation or received a W2 from a company.
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    Independent contractor I Contracted work, including contracted research.
    Lecture fees/Speakers bureau L Lecture fees or honoraria, travel fees or reimbursements when speaking at the invitation of a commercial company.
    Patents/Royalty P Beneficiary of patents and/or royalties for intellectual property.
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    Grant support S Grant support or other financial support from all sources, including research support from government agencies (e.g., NIH), foundations, device manufacturers, and\or pharmaceutical companies. Research funding should be disclosed by the principal or named investigator even if your institution receives the grant and manages the funds.
    Stock options, public or private corporation SO Stock options in a public or private company.
    Equity/Stock holder, public corporation US Equity ownership or stock in publicly traded firms, excluding mutual funds (listed on the stock exchange).

     

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