Crosslinking in children

The progression rate of keratoconus in children and adolescents is particularly high.
Around 90 percent of affected young people have active keratoconus, which continues to progress.

Children whose parents have keratoconus should undergo preventive examinations.
These are not the only special features when it comes to children and adolescents.
There is an increased risk of complications during surgery.

Time of treatment for children

While regular follow-up checks are carried out in adults and treatment is initiated as soon as the keratoconus progresses, faster action is required in children.

If the disease is diagnosed, it is important not to wait for it to worsen due to the high rate of progression.
As a rule, crosslinking should be performed as soon as possible.
In this way, maximum visual acuity can be maintained.

Effect of crosslinking on children

In children and adolescents, CXL achieves the same effect as in adults: a hardening of the cornea to stop the progression of keratoconus.
The success rate in children is comparable.
In fact, a faster effect is often observed.

Rapid improvement with CXL & rapid progression of the disease without therapy

After CXL treatment, the cornea improves quickly in children – faster than in adults.
The cornea stabilizes and sometimes even flattens out.
This contributes to an improvement in vision.
The results of CXL are significantly more intensive in children than in adults.

At the same time, a faster progression of keratoconus can be observed in children – the health of the eye can deteriorate massively within a few months.
This makes early treatment all the more important.

Treatment procedure

The procedure for crosslinking in children does not differ from the procedure for adults.
The treatment is generally performed on an outpatient basis under local anesthesia.
For younger children or those who prefer a general anesthetic, this is also possible after consultation.

Which method is best?

EPI-ON or EPI-OFF – which is better? A question we are often asked.
EPI-OFF is the classic method of CXL in which the ephitel is removed.
This ensures that the riboflavin can penetrate the eye.

Disadvantage: Pain may occur after the treatment.
In addition, a longer healing process is necessary, which is associated with an increased risk of infection.
This should be taken into account, especially in children.
Frequent eye rubbing can further increase the risk of infection.

EPI-ON – the newer method

Ongoing research into the CXL method now makes it possible to perform crosslinking without removing the ephitel.
Instead, eye drops are applied to increase the permeability of the riboflavin.

EPI-ON has the advantage that pain is rarely felt after the operation.
In addition, the risk of complications (e.g. infection) is lower and the healing process is usually significantly shorter.

Selection of the method

Both methods are comparable in terms of overall results, although EPI-OFF is said to be slightly more effective.
If your child suffers from particularly aggressive progression, the EPI-OFF method may be more advisable.

EPI-ON is suitable if the bandage lens and the application of eye drops are likely to cause difficulties.

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Author:

Dr. Victor Derhartunian

Nachdem er sein Handwerk von den beiden Pionieren der Laserchirurgie gelernt hat, gehört Dr. Victor Derhartunian zu den führenden Augenlaser-Chirurgen. Er leitet die Praxis in Wien und kann seine Patienten in fünf Sprachen beraten.