Collagen CXL in young keratoconic patients

Boston-Collagen crosslinking (CXL) provides good results in young patients with keratoconus, but the key to success in these young patients is rapid treatment upon presentation without waiting for disease progression, said Paolo Vinciguerra, MD.

“Don’t wait to treat,” advised Dr. Vinciguerra, Clinica Oculistica, Milan.

He reported a case in which a 12-year-old patient lost 186 µm of corneal thickness after only 4 months because collagen CXL had not been applied.

In addition to stopping disease progression, young patients frequently have substantial improvements in the best-corrected and uncorrected visual acuity levels after treatment, however, there is less reduction in cylinder, he said.

Dr. Vinciguerra also noted that young patients have a faster visual recovery after CXL treatment. The change in visual acuity 1 year postoperatively was similar to that in adult patients 2 years postoperatively.

In his experience with 66 patients with keratoconus treated with collagen CXL thus far, Dr. Vinciguerra said his take-home points are that collagen CXL halts progression of keratoconus, patients have a significant increase in their best-corrected visual acuity, and the group that achieves the best improvement is between the ages of 18 and 39 years.

“My suggestion is do not wait to treat until progression becomes evident,” Dr. Vinciguerra said. “Collagen crosslinking is safe. Careful patient screening is necessary. Frequently, patients present with an advanced stage of keratoconus. Young patients should undergo topography early.”

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