Workshop 23

Mar 04, 2017 by AAPOS editor in  Workshop

Corneal Collagen Crosslinking in Kids

Phoebe D. Lenhart; Erin D. Stahl; Asim Ali

Emory University School of Medicine
Atlanta, GA, USA

Purpose/Relevance:  Corneal collagen crosslinking (CXL), recently FDA-approved, appears to be safe and effective for adult and pediatric patients, potentially obviating the need for corneal transplantation. There is a need to find ways of reliably testing children in high risk groups. Furthermore, current protocols for performing CXL in children need to be elucidated.

Target Audience:  Pediatric Ophthalmologists, particularly those with interest in pediatric cornea

Current Practice:  The workshop will begin with a summary of the current situation (what to do with pediatric patients suspected of having keratoconus?) and an overview of CXL. Indications for CXL will be reviewed, as it is a newer procedure with which pediatric ophthalmologists may be unfamiliar. Presently, it is also difficult to know what to do with children with keratoconus who would require general anesthesia in order to have CXL.

Best Practice:  The panel will discuss potential ways to improve the management of children referred for evaluation of possible  keratoconus. CXL will be the focus of this discussion. Recommendations for intraoperative and postoperative care will be made. Information about treatment under general anesthesia, essential for some pediatric patients requiring CXL and not always discussed in the literature, will be included. Questions from the audience will be encouraged.

Expected Outcomes:  Our goal is to provide an opportunity for a group of pediatric cornea experts to engage in meaningful dialogue about and provide recommendations based on best current evidence for the management of pediatric keratoconus.

Format:  Brief didactic presentations including audience quizzing/ polling followed by panel discussion and audience participation

Summary:  Corneal collagen crosslinking may help some children avoid corneal transplantation, a procedure frought with peril for this population. Learning to identify which children have keratoconus, progressive keratoconus, or who might benefit from this procedure is a topic of high importance for pediatric ophthalmologists. Panel members will highlight key aspects of the current situation, challenges, and recommendations. The audience will have an opportunity to discuss strategies for improving the management of pediatric keratoconus with panel members.

References:  Vinciguerra P, Albe E, Frueh BE, Trazza S, Epstein D. Two-year corneal cross-linking results in patients younger than 18 years with documented progression of keratoconus. Am J Ophthalmol 2012;154:520-526.

McAnena L, O’Keefe M. Corneal collagen crosslinking in children with keratoconus. J AAPOS 2015;19:228-232.

Godefrooij DA, Soeters N, Imhof SM, Wisse RPL. Corneal cross-linking for pediatric keratoconus: Long-Term Results. Cornea 2016;35:954-958.

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