title: Iontophoretic transepithelial corneal cross-linking to halt keratoconus in pediatric cases: 15-month follow-up.
abstract: OBJECTIVE
  To report the results 15 months after transepithelial corneal cross-linking by iontophoresis of riboflavin performed in pediatric patients affected by keratoconus.
  
  
  METHODS
  Fourteen eyes of 14 pediatric patients [mean age 13 ± 2.4 (SD) years; range, 10-18 years] were treated. Riboflavin solution was administered by iontophoresis for 5 minutes, and then UVA irradiation (10 mW/cm) was performed for 9 minutes. The corrected distance visual acuity measured as decimal number, spherical equivalent, refractive astigmatism, simulated K, corneal coma, spherical aberration, and high-order aberrations for 5.0-mm pupil and the thinnest point were measured preoperatively and 3, 6, 12, and 15 months postoperatively. The endothelial cell density was evaluated. The paired Student t test was used to compare data during the follow-up.
  
  
  RESULTS
  Fifteen months after the procedure, the corrected distance visual acuity improved from 0.7 ± 1.7 to 0.8 ± 1.8 (P = 0.005). Spherical equivalent and refractive astigmatism as well as topographic and aberrometric data did not show significant changes. Also, the mean thinnest point and the endothelial cell density remained unchanged. The optical coherence tomography showed a nonhomogeneous but deep hyperreflective band with a fading effect extending through the anterior 180 μm of the cornea. No side effects were recorded.
  
  
  CONCLUSIONS
  Transepithelial collagen cross-linking by iontophoresis, unlike other transepithelial techniques, seems to halt pediatric keratoconus progression over 15 months. However, we did not record significant improvement in higher-order aberrations and topographic indices.
authors: *Department of Ophthalmology, Bambino Gesù IRCCS Children's Hospital, Rome, Italy; †Institute of Ophthalmology, Catholic University, Rome, Italy; and ‡Institute of Ophthalmology, Tor Vergata University, Rome, Italy.
authors: Luca
authors: L
authors: Buzzonetti
authors: Gianni
authors: G
authors: Petrocelli
authors: Paola
authors: P
authors: Valente
authors: Giancarlo
authors: G
authors: Iarossi
authors: Roberta
authors: R
authors: Ardia
authors: Sergio
authors: S
authors: Petroni
mesh_terms: D000293:Adolescent; D002452:Cell Count; D002648:Child; D003094:Collagen / Q000378:metabolism; D003319:Corneal Stroma / Q000378:metabolism*; D003432:Cross-Linking Reagents; D004728:Endothelium, Corneal / Q000473:pathology; D005500:Follow-Up Studies; D006801:Humans; D007478:Iontophoresis / Q000379:methods*; D007640:Keratoconus / Q000188:drug therapy* / Q000378:metabolism / Q000503:physiopathology; D017319:Photosensitizing Agents / Q000627:therapeutic use*; D012029:Refraction, Ocular / Q000502:physiology; D012256:Riboflavin / Q000627:therapeutic use*; D041623:Tomography, Optical Coherence; D014466:Ultraviolet Rays; D014792:Visual Acuity / Q000502:physiology
chemical_list: D003432:Cross-Linking Reagents; D017319:Photosensitizing Agents; D003094:Collagen; D012256:Riboflavin