Progression of Pediatric Keratoconus After Corneal Cross-Linking: A Systematic Review and Pooled Analysis

imagePurpose:

Corneal collagen cross-linking (CXL) is an effective treatment to slow down keratoconus (KC) progression in adults. Several studies have also shown efficacious outcomes in pediatric populations, yet no systematic analysis has been performed and no accepted definition for progression is available in children after CXL. This study aimed to establish the most commonly used criteria for progression and to conduct a systematic review of the literature with pooled analysis to assess children’s keratoconus progression after CXL.

Methods:

A systemic literature review combined with pooled analysis was performed on full-length studies of KC after CXL treatment in a pediatric population and the methods used to report progression were analyzed.

Results:

Thirty-seven studies (2078 eyes) were identified on the rates of KC progression after CXL. The most common method to report progression was increased Kmax, Kmean, or Ksteep by ≥1.0 diopter (78.3% of studies). Using these criteria, the mean pooled progression rate after epithelium-off CXL was 9.9% (95% confidence interval: 6.1% –14.6%, total pooled sample size: 1508 eyes) with high heterogeneity between studies [I2 = 86.48% (95% confidence interval: 80.98 – 90.39), P

Corneal Cellular and Neuroinflammatory Changes After SARS-CoV-2 Infection

imagePurpose:

The purpose of this study was to evaluate corneal cellular and ultrastructural changes and to quantify the neuroinflammatory process in patients after mild severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection.

Methods:

Thirty patients after SARS-CoV-2 infection and 41 age-matched controls were examined. All subjects underwent in vivo confocal microscopy of the corneal cell layers and subbasal nerve fibers with the Heidelberg Retina Tomograph II. Semiautomated analysis of basal epithelial, anterior and posterior stromal keratocyte, and endothelial cell density was performed. Dendritic cell (DC) density and area were also calculated, and subbasal nerve plexus morphology was analyzed.

Results:

The posterior stromal keratocyte density was significantly lower in patients after SARS-CoV-2 infection (P = 0.0006). DC density in the central cornea was significantly higher in patients after SARS-CoV-2 infection (P = 0.0004). There was a significant difference in the DC area between the 2 groups (P