Pediatrik İlerleyici Keratokonus Tedavisinde Hızlandırılmış Korneal Cross-Linking
Özet
Bu çalışma, pediatrik yaş grubundaki (8-17 yaş arası 15 hastanın 27 gözü) ilerleyici keratokonus hastalarında hızlandırılmış korneal çapraz bağlama (A-CXL) tedavisinin (9mW/cm2 UVA, 10 dk) etkinliğini ve güvenilirliğini retrospektif olarak incelemektedir. Tedavi öncesi ile tedavi sonrası 6. ve 12. aylardaki topoğrafik ve klinik parametreler karşılaştırılmıştır. Çalışma sonucunda, en iyi düzeltilmiş görme keskinliğinde (EİDGK) ameliyat öncesine göre 6. ve 12. aylarda istatistiksel olarak anlamlı düzeyde iyileşme (0,59 logmar'dan 0,42 logmar'a) saptanmıştır. Maksimum keratometri (kmax), simK1, simK2 ve korneal astigmatizma (KA) değerlerinde ameliyat öncesine göre hafif azalmalar görülse de bu değişimler istatistiksel olarak anlamlı bulunmamıştır. En ince noktadaki kornea kalınlığı (EİKK) ise korneal dokunun sıkılaşmasına bağlı olarak 6. ve 12. aylarda anlamlı şekilde azalmıştır. Bir yıllık takip süresi sonunda hastaların %78'inde keratokonus progresyonunun başarıyla durdurulduğu, %22'sinde ise ilerlemenin devam ettiği izlenmiştir. İşlem sonrasında hiçbir hastada komplikasyon veya yan etkiyle karşılaşılmamıştır. Sonuç olarak, A-CXL yöntemi pediatrik keratokonus hastalarında progresyonu önlemede etkili ve güvenli bir tedavi olup, kısa cerrahi süresiyle standart yönteme kıyasla genel anestezi süresini azaltma ve uyumu artırma avantajı sunmaktadır.
This study retrospectively examines the efficacy and safety of accelerated corneal cross-linking (A-CXL) treatment (9mW/cm2 UVA, 10 min) in pediatric progressive keratoconus patients (27 eyes of 15 patients aged 8-17). Topographic and clinical parameters were compared between the pre-treatment period and the 6th and 12th months post-treatment. The study revealed a statistically significant improvement in best-corrected visual acuity (BCVA) at the 6th and 12th months compared to baseline (from 0.59 logmar to 0.42 logmar). Although slight decreases were observed in maximum keratometry (kmax), simK1, simK2, and corneal astigmatism (CA) values compared to pre-operation, these changes were not statistically significant. Thinnest corneal thickness (TCT) decreased significantly at 6 and 12 months due to the compaction of corneal tissue. At the end of the one-year follow-up, keratoconus progression was successfully halted in 78% of the eyes, while progression continued in 22%. No complications or side effects were encountered in any patient after the procedure. In conclusion, A-CXL is an effective and safe treatment for preventing progression in pediatric keratoconus patients, offering advantages over the standard method by shortening general anesthesia duration and enhancing compliance due to its brief procedural time.
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